/Your Talent. Our Vision./At Anthem, Inc.,it's a powerful combination, and the foundation upon which we're creating greater 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.
Medical Director or Medical Director Associate
Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff. Primary duty is to interpret and apply existing medical policy and clinical guidelines to medical utilization management while complying with applicable regulations and time frames. Other duties may include, but are not limited to:
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.
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 the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.
Supports the medical management staff ensuring timely and consistent responses to members and providers.
Requires M.D. or D.O.
Current ABMS Certification required.
Must possess an active unrestricted MO medical license.
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
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background
Title: Medical Director or Medical Director Associate - 119505
Location: MO-St. Louis
Other Locations: Missouri
Requisition ID: 119505
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