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Medical Director

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Job Details
Job Order Number
JC173667689
Company Name
Anthem, Inc
Physical Address

Westchester, IL 60154
Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 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 at one of America’s leading health care companies and a Fortune Top 50 Company.

We are hiring for a Medical Director. This role is responsible for the administration of medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

Primary duties may include, but are not limited to:

Utilization Management Reviews

Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.

May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

Supports clinicians to ensure timely and consistent responses to members and providers.

Provides guidance for clinical operational aspects of a program.

Serves as a resource and consultant to other areas of the company.

May be required to represent the company to external entities and/or serve on internal and/or external committees.

May chair company committees.

Interprets medical policies and clinical guidelines.

May develop and propose new medical policies based on changes in healthcare. 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.

Qualifications

Requires M.D. or D.O.

Board certification by ABMS

Must possess an active unrestricted medical license to practice medicine or a health profession.

Minimum of 10 years clinical experience

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS41775-US


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