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Medical Director - Virginia Preferred (Remote) - PS28053Location: United StatesNewRequisition #: PS28053Your 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 medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff. Provides support to clinicians in daily tasks and ensuring timely and consistent responses for review determinations to members and providers. May include, but are not limited to: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. 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. Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program. Supports the medical management staff ensuring timely and consistent responses to members and providers.
M.D or D.O
Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed.
Family Medicine, Pediatrics or Emergency Medicine Board Certification preferred.
Must possess an active unrestricted medical license to practice medicine in state of residence; Multiple State License preferred. VA, MD, DC license preferred.
10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
1-3 years of experience with utilization review/ managed care background preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc 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.
Vacancy expired!