/ 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.
Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities and supporting the Medical Director in ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality of care management processes and activities. Primary duties may include, but are not limited to:
Provides support to clinicians in daily tasks and ensuring timely and consistent responses to members and providers, conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary.
May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees, and 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.
May be asked to assist in backup for Senior Clinical Officer functions.
Requires M.D. or D.O.
Requires current ABMS board certification.
Requires current, unrestricted medical license issued by the State of residence
Requires 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
Managed care 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 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 Operations Director Associate - 133648 - Nationwide Remote
Requisition ID: 133648
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