American Embassy Jobs in Indiana (NOW HIRING)

Anticipated End Date: 2026-08-14

Position Title: Appeals Medical Director – Medicare

Location: This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Candidates must be within a reasonable commuting distance unless accommodation is granted. Alternate locations may be considered.

• Conduct appeal reviews for physical health medical services to ensure appropriate and cost‑effective care.
• Develop and implement programs to improve quality, cost, and outcomes.
• Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
• Identify cost‑of‑care opportunities and lead initiatives to increase effectiveness and quality.
• Support clinicians with timely and consistent responses to members and providers.
• Conduct peer‑to‑peer clinical case reviews with attending physicians or other ordering providers.
• Serve as a resource and consultant to other areas of the company.
• Represent the company to external entities and/or serve on internal and external committees; chair company committees if required.
• Interpret medical policies and clinical guidelines; develop and propose new policies.
• Lead, develop, direct, and implement clinical and non‑clinical activities that impact health care quality, cost, and outcomes.

• MD or DO with board certification from American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• 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 consideration; cannot be 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 a minimum of 5 years of health care experience is required.
• Preferred: Primary Care specialties; Utilization Management or Appeals experience.

In addition to salary (range $247,840 to $446,112 for specified locations), Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable laws. Applicants requiring accommodation should submit the Accessibility Accommodation Request Form.