/This position is located in Chicago, Illinois/
/Your Talent. Our Vision./AtAIM Specialty Health(AIM), a proud member of the Anthem, Inc. family of companies, 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.
Responsible for interpretation and system implementation of clinical criteria from health plan medical policies in the Oncology program at AIM.
Primary duties may include, but are not limited to:
Research and evaluates health plan medical policy rules for new client implementations, new drug implementations, or during policy update processes.
Develop clinical algorithms used in the implementation process for client medical policy review.
Respond to inquiries from providers regarding UM review and medical policy interpretation.
Work with Medical Directors on development of strategies and process to enhance and expedite the clinical implementation of new clients, new medical policies, and updated coverage determinations.
Serve as a liaison for clinical content implementation efforts to the clinical team and the clinical content vendor.
Research questions and issues from internal and external inquiries as they relate to implemented medical policies.
Provide leadership for clinical QA process for content implementations and updates.
Review reporting from clinical content vendor related to medical policy updates.
Manage multiple client UM drug lists, including coding, drug names, and implementation requirements, monitoring for consistency and accuracy.
Limited travel may be required.
_About AIM Specialty Health_
AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation's leading health benefits companies.
AIM provides innovative clinical solutions that focus on today's most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.
With evidence-based medicine, technology, people and processes, we support clinical appropriateness review, provider collaboration and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.
Today, our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses, and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online ProviderPortal and experienced contact center-based teams that is enabled by our business platform.
Our pioneering spirit and dedication to improve health care continues to produce significant industry-first advancements, quality recognition achievements, and high satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)
We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL, as well as Glendale, CA.
To learn more, visit www.aimspecialtyhealth.com.
The qualified candidate will have
BA or BS degree;
2 years of related experience including clinical experience and should include clinical utilization operations experience
or any combination of education and experience, which would provide an equivalent background.
Nursing or clinical degree preferred;
Oncology background or experience with oncology medical policy review highly preferred.
Strong knowledge of clinical utilization review systems, performance, and production activities
Good written, oral, listening and interpersonal communication skills required
Excellent computer skills, including experience with Word, Excel, Visio, and PowerPoint
Ability to relate well across all levels within the organization
Strong problem-solving skills
Self-directed, highly motivated
Experience with Microsoft office, including Excel and Visio preferred.
/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. /
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: Oncology Medical Policy Analyst Senior AIM 132990
Requisition ID: 132990
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