Anthem Inc. Jobs

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Anthem, Inc. Medical Director in Harrisburg, Pennsylvania

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Responsible for the administration of physical and/or behavioral 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 identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May 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, and patients’ office visits with providers and external physician

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 and Interpret 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

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

5 years of experience providing health care is required.

REQNUMBER: PS41537-US

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