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Anthem, Inc. Associate Medical Director in Harrisburg, Pennsylvania

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Position: Associate Medical Director Location: Seven Fields, PA

The Associate Medical Director is 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 assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.

  • 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.

Qualifications

  • Education: M.D. or D.O. with board certification approved by the American Board of Medical Specialties

  • Licensure: Active unrestricted medical license in the state of PA to practice medicine

  • Experience: 5 years of clinical experience or any combination of education and experience which would provide an equivalent background.

AnEqualOpportunityEmployer/Disability/Veteran

REQNUMBER: PS40166

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