This position may be filled as part time (20 hours) or full time (40 hours). If full time, the candidate must reside in the Des Moines, IA area and be willing to commute to the Anthem office on most days. If part time, this position may be filled in any US state and the candidate will travel to Des Moines, IA on a quarterly basis.
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. 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.
Requires M.D. or D.O.;
Requires Board certification approved by the American Board of Medical Specialties
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
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
Title: Psychiatrist Medical Director or Medical Director Associate - 119040 - Part Time or Full Time
Other Locations: IA-Des Moines
Requisition ID: 119040
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