Anthem, Inc. Medical Director in Richmond, Virginia
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.
We are hiring a Medical Director for a large Medicare account serving a group of retirees in the State of New York.
Primary duties may include, but are not limited to:
Performs utilization management reviews, including acute and post-acute transitions, prior authorization, post-service reviews, and appeals.
Collaborates with fellow clinicians to ensure timely and consistent responses to members and providers.
Conducts peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss and review determinations.
May be responsible for developing and implementing programs to improve quality, cost, and health outcomes.
May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
May be required to represent the company to external entities and/or serve on internal and/or external committees.
May chair company, line of business, and team committees.
Interprets 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.
Partners with the team account/client manager to address and resolve escalated issues and provide exceptional service to our client, members, and providers.
Collaborate with Quality and STARs teams as well as with various vendor partners
Interprets data to identify strengths and opportunities in our healthcare management practices
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
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.
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Must be able to participate in weekend and holiday call rotation.
Experience at a health technology start-up, healthcare payer, a delivery system, healthcare consulting firm, multinational company, or other professional degrees (e.g., M.B.A., J.D., M.P.H.) welcome but not required.
Ability to effectively work in a multi-disciplinary team structure with multiple teams comprising a larger team
Experience with Medicare patients in both clinical practice and utilization management
Familiarity with the New York/ Tri-State area market is a plus but is not mandatory
Data analysis and external client-facing experience are strongly preferred.