Medical Director Associate – CarelonRx

Position Title

Medical Director Associate – CarelonRx

Location

Remote – California (Costa Mesa, 3080 Bristol St, Ste 200). This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions. Candidates must be within a reasonable commuting distance from the posting location, unless an accommodation is granted as required by law.

Job Description

CarelonRx delivers market‑leading pharmacy benefit management and medication dispensing services. The Medical Director Associate supports pharmacy prior authorization reviews to ensure turnaround time and regulatory compliance.

Responsibilities

• Provide clinical guidance for pharmacy prior authorizations using CarelonRx clinical guidelines.
• Support clinicians to ensure timely and consistent responses to members and providers.
• Conduct peer‑to‑peer prior authorization reviews for medications with attending physicians or ordering providers to discuss review determinations.
• Participate in a physician on‑call weekend rotation for a 24x7 unit.

Qualifications

• Medical degree (MD or DO) with board certification approved by ABMS or AOA.
• Active unrestricted medical license to practice in the United States.
• Minimum of 5 years of clinical experience or equivalent education and experience.
• Must be located in the United States when conducting utilization review or appeals; cannot be on a US military base, vessel or embassy.

Preferred Qualifications

• Experience in pharmacy prior authorization and benefit management.
• Ability to work remotely with occasional on‑site commitments.

Salary

$231,504 – $396,864 (based on location, experience, and qualifications).

Job Level & Shift

Director Equivalent – 1st Shift (United States of America)

Benefits

Comprehensive benefits package including health, dental, vision, disability, 401(k) with match, stock purchase plan, and wellness programs.

Equal Employment Opportunity

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 expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable laws. Applicants requiring accommodations may contact Qualified applicants with arrest or conviction records will be considered in accordance with federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.