Anthem, Inc. Medical Director Associate in Cary, North Carolina
SHIFT: Day Job
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.
Responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review.
Primary duties may include, but are not limited to:
May provide clinical guidance for programs.
Supports clinicians to ensure 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, 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.
May participate in a physician on-call rotation for a 24x7 unit.
May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Under direction, may be responsible for the administration of medical services for company health plans including medical policies.
Serves as a resource and consultant to other areas of the company.
May interpret existing medical policy.
May be required to represent the company to external entities and/or serve on internal and/or external committees.
Requires M.D. or D.O.
Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed
Must possess an active unrestricted medical license to practice medicine or a health profession.
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background
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.