/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 willdrive 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 Commercial health plans and ensures clinical integrity of broad and significant clinical programs, particularly of utilization management programs.
Primary duties may include, but are not limited to:
Evaluates requests for service coverage for medical necessity
Interprets existing policies.
Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
Supports the WI Clinical Nursing team with bi weekly focused case conferences.
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.
Requires MD or DO
At least 5 years of post-residency clinical experience required.
Requires current, unrestricted WI license to practice medicine
Current ABMS recognized board certification required.
Previous UM/appeals experience preferred.
Internal Medicine, Emergency Medicine, and/or Family Practice specialties 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
Ability to work 20 hours afternoon hours in central time zone (four hour per day m-f )
/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran/
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Medical Director Associate (20 hours - Part -Time) Remote -136435
Requisition ID: 136435
A little about us:
We have shared values and a similar mission.