Anthem Medical Director - Remote (PS9515) in Mason, Ohio

Medical Director - Remote (PS9515)

New

Location: United States

Field: Medical

Requisition #: PS9515

Post Date: 4 days ago

Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we’re creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.

Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program.

Responsible for the administration of medical management services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies of the Medicare business unit.

Primary duties may include, but are not limited to:

  • Evaluates requests for service coverage for medical necessity

  • 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.

  • Supports the Medical Management staff ensuring timely and consistent responses to members and providers.

  • 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 Anthem to external entities and/or serve on external committees

  • Requires MD or DO

  • At least 10 years of post-residency clinical experience required.

  • Requires current, unrestricted license to practice medicine in state of residence

  • Current ABMS recognized board certification required

  • Internal Medicine, Surgery, Pediatrics or OBYN specialties preferred

  • Previous UM/appeals experience preferred

  • 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 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran .