Anthem, Inc Medical Director or Associate Medical Director - FUTURE OPPORTUNITIES ONLY - 130488 in Boston, Massachusetts
Medical Director or Associate Medical Director - FUTURE OPPORTUNITIES ONLY - 130488
Location: United States
Requisition #: 130488
Post Date: Jun 29, 2017
IN ADDITION TO OUR CURRENT OPENINGS, WE CONTINUE TO SOURCE FOR TOP TALENT.
THIS POSTING IS FOR FUTURE OPPORTUNITIES ONLY:
Medical Director or Associate Medical Director:
Location: Many Anthem Medical Directors work from home offices with occasional travel to Anthem sites as required.
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 current Board certification approved by the American Board of Medical Specialties
Requires active unrestricted medical license to practice medicine in a US state.
Requires at least 5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
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.