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CWSP Medical Director - Wound UM Review MD/DO - myNEXUS - Sign on Bonus $1,000 in Helena, Montana

CWSP Medical Director - Wound UM Review MD/DO - myNEXUS - Sign on Bonus $1,000

  • Job Family: Medical and Clinical

  • Type: Full time

  • Date Posted:Nov 09, 2022

  • Req #: JR20736

Location:

  • TN, Brentwood

  • Alabama, Alabama

  • Virginia, Virginia

  • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint

  • Colorado, Colorado

  • Ohio, Ohio

  • Minnesota, Minnesota

  • Kentucky, Kentucky

  • Massachusetts, Massachusetts

  • Tennessee, Tennessee

  • Florida, Florida

  • Mississippi, Mississippi

  • Georgia, Georgia

  • New York, New York

Description

Clinical Operations Medical Director- Wound

myNEXUS

Remote

Sign on Bonus: $1,000

Job Summary:

Responsible for performing utilization management on wound and home health cases. Also responsible for leading wound physician efforts in supporting the medical management staff to ensure timely and consistent medical decisions to members and providers.

Primary duties may include, but are not limited to:

  • Provides oversight to wound physicians and ensures timely completion of clinical case reviews for their board certified specialty.

  • Works collaboratively with wound physicians and wound nurses to support the build of the wound management program for home health

  • Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.

  • Makes medical necessity determinations for grievance and appeals appropriate for their specialty.

  • Ensures consistent use of company medical policies when making medical necessity decisions.

  • Educates and provides direct medical coverage decision support as needed for team of physician advisors.

Minimum Requirements:

  • Requires a MD or DO degree.

  • Wound certification, CWSP or Equivalent, strongly preferred.

  • Board certification in related specialty required.

  • 5 years of post-residency experience with at least 2 of those years focused on providing wound care strongly preferred.

  • Minimum of 1 years experience with clinical case reviews for medical necessity required. 2 or more years strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $160,767 to $321,560.

Locations: Colorado; Nevada, Jersey City, NJ; New York City, NY; Ithica, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

EEO is the Law

Equal Opportunity Employer / Disability / Veteran

Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

  • EEO Policy Statement

  • EEO is the Law Poster

  • EEO Poster Supplement-English Version

  • Pay Transparency

  • Privacy Notice for California Residents

Elevance Health, Inc. is an E-verify Employer

Need Assistance?

Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664

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