Anthem Medical Director Associate -Remote in CA: Part Time (20-30 hours)-PS8926 in Diamond Bar, California

Medical Director Associate -Remote in CA: Part Time (20-30 hours)-PS8926

Location: California, United States

Field: Medical

Requisition #: PS8926

Post Date: Jun 29, 2018

Your 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.

Please Note: If this is not a straight backfill, please consult with your HR Business Partner prior to posting/using this job.

Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities and supporting the Medical Director in ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality.

Primary duties may include, but are not limited to:

  • Provides support to clinicians in daily tasks and ensuring timely and consistent responses to members and providers.

  • Conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary.

  • Assists in the practitioner appeal, criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.

  • Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees.

  • May participate in a physician on-call rotation for a 24x7 pre-certification unit.

  • Requires M.D. or D.O.; Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed, with board certification in Child and Adolescent Psychiatry preferred.

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

  • 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.

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

  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.An Equal Opportunity Employer/Disability/Veteran

Requires

  • M.D. or D.O.in state of residence

  • Board certification approved by the American Board of Medical Specialties (ABMS).

  • Board certification in Child and Adolescent Psychiatry is preferred.

  • 5 years of clinical experience

  • 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 2017 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.