Medical Director Associate - Oral Health

Medical Director Associate - Oral Health (Utilization Mgmt.)• This is an Individual Contributor Role.*Location: This position will work a Hybrid Model (remote and office). Ideal candidates Must live within 50 miles or a 1 hour commute to an Elevance Health corporate office.Work Shift Hours: Monday through Friday, 40 hrs a week .The Medical Director Associate - Oral Health (UM) is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review focused on oral health.How you will make an impact:• May provide clinical guidance for primarily oral health programs.• Supports clinicians to ensure timely and consistent responses to members and providers.• Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients’ office visits with providers and external physicians.• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.• May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.• Under direction, may be responsible for the administration of medical services for company health plans including medical policies.• Serves as a resource and consultant to other areas of the company.• May interpret existing medical policy.• May be required to represent the company to external entities and/or serve on internal and/or external committees.Minimum Requirements:• Requires MD or DO and Board certification approved by one of the following certifying boards is required , where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).• Must possess an active, unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.• Minimum of 5 years of clinical experience ; or any combination of education and experience, which would provide an equivalent background.• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.Preferred Skills, Capabilities and Experiences:• American Board of Oral and Maxillofacial Surgery (ABOMS)• 10 years of clinical practice.• Managed care experience.• Experience with Medicaid.