Anthem, Inc. Medical Director - PS37906 in Melville, New York
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
Medical Director - Remote
This position will be supporting our North East Commercial Business.
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 Commercial business unit. Will be reporting to the Director of Medical Operations.
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.
M.D. or D.O. – an active state license required
ABMS Board certification required.
Internal or Family Medicine Board Certification preferred. Other specialties will be considered.
5 years clinical experience or any or any combination of education and experience, which would provide an equivalent background.
Previous UM/appeals experience preferred.
Managed care background preferred.
Strong oral and written communication skills required.
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 2019 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