Job ID JP00046697 Anticipated Start Date August 10 2026 Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Primary duties may include but are not limited to Ensures timely completion of clinical case reviews for their board-certified specialty. 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 medical policies when making medical necessity decisions. Brings to their supervisors attention any case review decisions that require Medical Director review or policy interpretation. Requirements Requires MD/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. Job TypeContract Additional Details Microsoft Office Suite experience. Exposure to ordering and reviewing outpatient Physical therapy Occupational therapy and Speech therapy. Work hours Monday-Friday 900am-530pm in your time zone. Will consider 33-40 hours per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager contractors are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. About BCForward Founded in 1998 on the idea that industry leaders needed a professional service and workforce management expert to fuel the development and execution of core business and technology strategies BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis IN with an Offshore Development Center in Hyderabad India BCforward's 6000 consultants support more than 225 clients globally. BCforward champions the power of human potential to help companies transform accelerate and scale. Guided by our core values of People-Centric Optimism Excellence Diversity and Accountability our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work. BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin or protected veteran status and will not be discriminated against based on disability. To learn more about how BCforward collects and uses personal information as part of the recruiting process view our Privacy Notice and CCPA Addendum. As part of the recruitment process we may ask for you to disclose and provide us with various categories of personal information including identifiers professional information commercial information education information and other related information. BCforward will only use this information to complete the recruitment process. This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration. Pay Rate Range 72.14 - 137.76 USD hourly Additional Notes The pay range is the range BCForward 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. Benefits Information BCForward offers all eligible employees a comprehensive benefits package including but not limited to major medical HSA dental vision employer-provided group life voluntary life insurance short-term disability long-term disability and 401k. 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. This does not encompass additional non-standard compensation (e.g. benefits paid time off per diem etc.).