Anthem Sleep Medicine Senior Physician Advisor AIM 134369 in Glendale, California
Sleep Medicine Senior Physician Advisor AIM 134369
Location: Deerfield, Illinois, United States
Requisition #: 134369
Post Date: Aug 09, 2018
This position may be located in Westchester or Deerfield, IL; or in Glendale, CA
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.
AIM is currently seeking a Board-Certified Sleep Specialist to participate in pre-authorization and quality improvement solutions for sleep studies and general medicine. Physician Reviewers determine the medical necessity of outpatient requests using clinical appropriateness guidelines and health plan medical policy.
Successful candidates will:
Perform physician-level case review, following initial nurse review, of sleep studies, durable medical equipment, and high-tech diagnostic imaging.
Determine medical necessity of requests using AIM Clinical Appropriateness Guidelines, client-specific health plan medical policy, and CME Coverage Determinations, as applicable.
Conduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.
Suggest alternative studies and sites of care to ordering providers when appropriate
Provide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered modalities.
Actively participate in physician team meetings.
Demonstrate and maintain knowledge of relevant policies and regulations pertaining to sleep management, and imaging modalities.
Actively participate in groups that develop, revise and enhance clinical appropriateness guidelines
Perform first level provider appeals of coverage decisions.
Obtain additional state licensure based upon state regulations and health plan needs
Adhere to all AIM Specialty Health protocols, policies, and procedures
About AIM Specialty Health
AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation’s leading health benefits companies.
AIM provides innovative clinical solutions that focus on today’s most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.
With evidence-based medicine, technology, people and processes, we support clinical appropriateness review, provider collaboration and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.
Today, our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses, and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online ProviderPortal and experienced contact center-based teams that is enabled by our business platform.
Our pioneering spirit and dedication to improve health care continues to produce significant industry-first advancements, quality recognition achievements, and high satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)
We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL, as well as Glendale, CA.
To learn more, visit www.aimspecialtyhealth.com.
Qualified Candidates will have:
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine
Current Board Certification in a Sleep Medicine subspecialty under the American Board of Medical Specialties.
Demonstrated knowledge of current practice standards in general medicine and sleep medicine.
Strong oral communication and interpersonal skills
Computer literacy with the ability to learn new applications
Strong analytical skills
Ability to multi-task
Ability to work both independently and in a team environment
Ability to work in a dynamic, fast-paced environment
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.
An Equal Opportunity Employer/Disability/Veteran