Clinical Operations Associate Medical Director- Sleep Medicine - AIM
Company: Elevance Health
Posted on: March 12, 2023
Associate Medical Director Sleep Medicine AIM is currently
seeking a Board-Certified Sleep Medicine physician. Remote -
Location Flexible AIM Specialty Health is a benefit-management
leader in Illinois and a proud member of Elevance Health's family
of companies. Our platform delivers significant cost-of-care
savings across an expanding set of clinical domains, including
radiology, cardiology and oncology. Job Summary: AIM is currently
seeking a Sleep Specialist to participate in pre-authorization and
quality improvement solutions for sleep studies and high-tech
general medicine diagnostic imaging. Medical Directors in Clinical
Operations determine the medical necessity of outpatient radiology,
cardiology and sleep management requests using clinical guidelines
and health plan medical policy. Primary duties may include, but are
not limited to:
- Determine medical necessity of requests using applicable
clinical criteria, which may include AIM Appropriateness
Guidelines, client-specific health plan medical policy, well
established evidenced based guidelines, and CMS Coverage
Determinations, as applicable.
- Perform physician-level case review, following initial nurse
review, of sleep studies, durable medical equipment, and high-tech
- Conduct peer-to-peer consultations with ordering physicians,
physician assistants, and advanced practice nurses to provide
education regarding established guidelines and accepted standards
of care regarding studies and site of service.
- Discuss clinically appropriate alternative treatments, imaging
studies and sites of care with ordering providers when consistent
with applicable clinical criteria.
- Provide education regarding applicable clinical criteria.
- Provide support and educate clinical and non-clinical staff to
foster understanding of the principles associated with appropriate
use of covered modalities.
- Actively participate in physician team meetings.
- Demonstrate and maintain knowledge of relevant policies and
regulations pertaining to sleep management, and imaging
- Actively participate in groups that develop, revise, and
enhance clinical appropriateness guidelines
- Perform first level provider appeals of coverage
- Obtain additional state licensure based upon state regulations
and health plan needs
- Adhere to all AIM Specialty Health protocols, policies, and
procedures Desired Skills and Abilities:
- Requires an MD/DO
- Board certification in a medical specialty required. Board
Certification by American Board of Medical Specialties in Sleep
Medicine strongly preferred.
- 3-5 years of clinical practice experience past fellowship
training is desirable For candidates working in person or remotely
in the below locations, the salary* range for this specific
position is $155,605 to $280,076. Locations: California; Colorado;
Nevada; Washington State; Jersey City, NJ; New York City, NY;
Ithaca, 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.
Keywords: Elevance Health, Cerritos , Clinical Operations Associate Medical Director- Sleep Medicine - AIM, Executive , Cerritos, California
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