Medical Director - Medicare West Coast - PS36554

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 benefits companies and a Fortune Top 50 Company.Note: This position is remote and can reside in any location, however this position must operate on Pacific Standard Time office hours. Responsible for the administration of physical health medical services, to ensure the appropriate and most cost effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. Primary duties may include, but are not limited to:

Supports clinicians to ensure timely and consistent responses to members and providers.

Provides guidance for clinical operational aspects of a program.

Conducts peer-to-peer clinical reviews with attending physicians or other 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.

Serves as a resource and consultant to other areas of the company.

May be required to represent the company to external entities and/or serve on internal and/or external committees.

May chair company committees.

Interprets medical policies and clinical guidelines.

May develop and propose new medical policies based on changes in healthcare.

Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

Identifies and develops opportunities for innovation to increase effectiveness and quality.

Qualifications

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. 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, and 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.

For Clinical Solution Team (CST) organization only, 5 years of experience providing health care is required. 10 years of clinical experience does not apply.

Analytics and external client facing experience strongly preferred.

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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS36554