Anthem Medical Director/ Medical Director Associate - Remote (PS4818) in Norfolk, Virginia

Medical Director/ Medical Director Associate - Remote (PS4818)


Location: United States

Field: Medical

Requisition #: PS4818

Post Date: 5 days ago

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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

Responsible for the administration of medical management services for growing book of business of company employee group retiree clients 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:

  • Develops and communicated medical costs management strategies to internal stakeholders (P and Leaders) and external stakeholder (employer groups

  • 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.

  • MD; or DO

  • Requires active unrestricted medical license to practice medicine in state of residence.

  • 5 years clinical of experience with extensive managed care knowledge.

  • ABMS Board certification required.

  • Previous UM/appeals experience preferred.

  • Internal Medicine, Emergency Medicine, and/or Family Practice Board Certification preferred.

  • Medicare experience preferred.

  • Employer group retiree experience preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.