Job Details

ID #4123883
State California
City Newburypark
Full-time
Salary USD TBD TBD
Source Anthem, Inc.
Showed 2020-06-11
Date 2020-06-12
Deadline 2020-08-11
Category Et cetera
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Medical Director - PS36063

California, Newburypark 00000 Newburypark USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At 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 communities. Join 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 benefits companies and a Fortune Top 50 Company. Responsible for the administration of physical health medical services, to ensure the appropriate and most cost effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May serve as a resource to staff including Medical Director Associates, case managers and non-clinical staff. . 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, and patients’ office visits with providers and external physicians.

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

Requires M.D. or D.O.

Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed.

10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.

Must possess an active unrestricted medical license to practice medicine or a health profession.

Internal Medicine, Family Medicine, or Emergency Medicine certified preferred. Other specialties will be considered.

Utilization Management background a plus.

Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS36063

Vacancy expired!

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