Anthem, Inc. Medical Director in Harrisonburg, Virginia
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.
This position will be supporting our New England Commercial Business (NH, CT, ME). This position allows remote work and will be working East Coast Standard Business Hours (EST).
Responsible for the administration of medical management services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies of the Commercial business unit. Will be reporting to the Director of Medical Operations.
Primary duties may include, but are not limited to:
Evaluates requests for service coverage for medical necessity
Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
Identifies and develops opportunities for innovation to increase effectiveness and quality.
Serves as a resource and consultant to other areas of the company.
May chair or serve on company committees.
May be required to represent Anthem to external entities and/or serve on external committees.
M.D. or D.O required.
Board certification approved by the American Board of Medical Specialties or American Osteopathic Association required.
Must possess an active unrestricted medical license to practice medicine in the state(s) indicated by the posting.
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background required.
Internal Medicine, Family Practice, Emergency Medicine Board Specialty preferred. Other specialties will be considered.
1 - 3 years UM, managed care experience preferred.
Ability to work EST hours with some on-call weekend coverage required.
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.
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.