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Associate Medical Director, Clinical Operations - Neurologic

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Job Details
Job Order Number
JC136860876
Company Name
Anthem, Inc
Physical Address

Deerfield, IL 60015
Job Description

Associate Medical Director, Clinical Operations – Neurologic Surgery (AIM) Los Angeles Area – PS17922

Location: Los Angeles, California, United States

Requisition #: PS17922

Post Date: Oct 14, 2019

Candidate should reside in the Los Angeles area. Can work remote (in LA area) at Manager’s discretion.

Your Talent. Our Vision. At AIM 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 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.

AIM is currently seeking a
Board-Certified Neurologic Surgeon to participate in pre-authorization and quality
improvement solutions for musculoskeletal procedures involving the spine, and
high-tech diagnostic imaging. Physician Advisors determine the
medical necessity of requests using clinical appropriateness guidelines and
health plan medical policy.

Primary duties may include,
but are not limited to:

+ Determines the medical necessity of requestsusing clinical criteria.

+ Performs physician-level case review ofmusculoskeletal utilization requests.

+ Conducts peer-to-peer consultation withordering physicians, physician assistants and advanced practice nursesregarding established guidelines and accepted standards of care as itrelates to treatments, surgical procedures, imaging and appropriate sitesof service.

+ Provides education regarding applicableclinical criteria and discusses clinically appropriate alternativesurgical and non-surgical treatments.

+ Performs first level provider appeals ofcoverage decisions.

+ Provides support and education to internalclinical and non-clinical staff regarding the principles associated withappropriate musculoskeletal diagnoses, treatments, and management.

+ Participates in physician team meetings.

+ Participates in groups that develop, reviseand enhance clinical appropriateness guidelines.

Qualified Candidates will have:

+ Current unrestricted medical license(s) as aDoctor of Medicine or Doctor of Osteopathic Medicine in appropriatestate(s).

+ M.D. or D.O. Board certification by theAmerican Board of Neurologic Surgery, American Osteopathic Board ofNeurosurgery, the American Board of Orthopedic Surgery, or AmericanOsteopathic Board of Orthopedic Surgery.

+ Experience performing standard neurosurgicalspine procedures independently.

+ 3-5 years of clinical practice experience pastfellowship training preferred.

+ Extensive spine surgery experience preferred.

+ Demonstrated knowledge of current practicestandards in neurosurgery.

+ Strong oral communication and interpersonalskills.

+ Computer literacy with the ability to learnnew applications.

+ Strong analytical skills.

+ Ability to multi-task.

+ Ability to work both independently and in ateam environment

+ Ability to work in a dynamic, fast-pacedenvironment.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.

An Equal Opportunity Employer/Disability/Veteran


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