Location This is a virtual role with required in‑person training sessions. Candidates must live within a reasonable commuting distance of the posting location(s) unless an accommodation is granted. Responsibilities Conduct appeal reviews for physical health medical services to ensure appropriate and cost‑effective care. Support clinicians for timely and consistent responses to members and providers. Provide guidance on clinical operational aspects of a program. Conduct peer‑to‑peer clinical case reviews with attending physicians or other ordering providers. Serve as a resource and consultant for other areas of the company. Represent the company to external entities and/or serve on internal and external committees, including chairing company committees. Interpret medical policies and clinical guidelines. Develop and propose new medical policies based on changes in healthcare. Lead, develop, direct, and implement clinical and non‑clinical activities that impact health‑care quality, cost, and outcomes. Identify and develop opportunities for innovation to increase effectiveness and quality. Minimum Requirements MD or DO with board certification from the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) where applicable. Active unrestricted medical license to practice medicine or a health profession. Located in a U.S. state or territory when conducting utilization review or appeals; not located on a U.S. military base, vessel, or embassy. Minimum of 10 years of clinical experience, or an equivalent combination of education and experience. For Health Solutions and Carelon organizations only, a minimum of 5 years of healthcare experience is required. Preferred Qualifications Board certification in Cardiology. Experience in utilization management or appeals. Salary and Benefits Salary range for this position: $247,840.00 to $446,112.00, depending on geographic location, work experience, education, and skill level. In addition to salary, Elevance Health offers a comprehensive benefits package that includes incentive and recognition programs, equity stock purchase, 401(k) contribution, medical, dental, vision, disability benefits, and other professional development resources. EEO Statement Elevance Health is an Equal Employment Opportunity employer. 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. #J-18808-Ljbffr