Anthem MD - Physician Advisor Senior (Part-Time) - Remote (Andover, MA area) - PS9102 in Andover, Massachusetts

MD - Physician Advisor Senior (Part-Time) - Remote (Andover, MA area) - PS9102

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Location: Andover, Massachusetts, United States

Field: Medical

Requisition #: PS9102

Post Date: 2 days ago

Your Talent. Our Vision. At UniCare , a subsidiary of 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.

MD - Physician Advisor Senior (Part-Time) - Remote - Must reside within commutable distance to Andover, MA

The MD - Physician Advisor Senior is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Primary duties may include, but are not limited to:

  • Ensures timely completion of clinical case reviews for their board certified specialty.

  • Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.

  • Makes medical necessity determinations for grievance and appeals appropriate for their specialty.

  • Ensures consistent use of company medical policies when making medical necessity decisions.

  • Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.

Qualifications:

  • Requires an MD or DO

  • 1 year of experience with clinical case reviews for medical necessity.

  • Current ABMD and/or AOA Board certified in a medical specialty required.

  • Current, unrestricted license to practice medicine in the Commonwealth of Massachusetts required.

  • This job is paid on an hourly basis for part-time work.

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. An EqualOpportunityEmployer/Disability/Veteran