Anthem, Inc. Medical Director Lead (Medical Oncology) AIM Specialty Health in Hingham, Massachusetts
SHIFT: Day Job
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.
Responsible for leading physician efforts in supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Primary duties may include, but are not limited to:
Provides oversight to physicians and ensures timely completion of clinical case reviews for their board certified specialty.
Ensures consistent use of company medical policies when making medical necessity decisions.
Educates and provides direct medical coverage decision support as needed for team of physician advisors.
Ensures system integrity in alignment with all relevant clinical criteria as related to sources which include client medical policy, compendia alignment, pathway requirements, and CMS guidance.
Interprets and provides feedback on client medical policy.
Provides oversight for clinical integration during implementations, clinical updates, and any system clinical change requirements.
Provides clinical direction for new oncology program expansions.
Participates in AIM Clinical Pathway development and system implementations.
Develops and/or supports workflow and best practices for clinical integration processes.
Requires an MD.
2 years of experience with clinical case reviews for medical necessity preferred.
Board certification in Medical Onocology, Hematology, or Pediatric Hematology and Oncology.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
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