Job details
Job type full-time
Full job description
Description
Shift: day job
Schedule: full-time
Your talentOur visionAt anthem, inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communitiesJoin us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of america`s leading health care companies and a fortune top 50 company.
Locations: remote position; central states (mo, ky, in, oh, tn, wi, la, ia)
Schedule: standard hours + rotating on-call weekend requirement (no more than once every 8 weeks)
The medical director supports the medicare business in the central region and is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is receivedMay be responsible for developing and implementing programs to improve quality, cost, and outcomesMay provide clinical consultation and serve as a clinical/strategic advisor to enhance the clinical operationsMay identify cost of care opportunitiesMay serve as a resource to staff including medical director associatesMay be responsible for an entire clinical program.
Primary duties may include but are not limited to:
Supports clinicians to ensure timely and consistent responses to members and providers
Provides guidance for clinical operational aspects of a program
Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations
Serves as a resource and consultant to other areas of the company
May be required to represent the company to external entities and/or serve on internal and/or external committees
May chair company committees.
Interprets medical policies and clinical guidelines
May develop and propose new medical policies based on changes in healthcare
Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes
Identifies and develops opportunities for innovation to increase effectiveness and quality
Qualifications
M.dOr d.o required.
5 years of clinical experience and additional experience in extensive managed care knowledge (or any combination of education and experience, which would provide an equivalent background) required.
Requires a current unrestricted medical licensure in any of the states indicated by the posting.
Current and active board certification approved by abms or aoa requiredFamily medicine, internal medicine, emergency medicine board certification preferredOther specialties will be considered.
Preferred qualifications:
Utilization management experience a plus.
Knowledge and experience with population or segment health management is a plus.
Medicare experience a plus.
Team player, collaborative, and capable of independent work.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, incHas been named as a fortune 100 best companies to work for®, is ranked as one of the 2020 world’s most admired companies among health insurers by fortune magazine, and a 2020 america’s best employers for diversity by forbesTo learn more about our company and apply, please visit us at careers.antheminc.comAn equal opportunity employer/disability/veteranAnthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all anthem positions.
