Anthem, Inc. Medical Director (Commercial) California / West Coast pref. in San Jose, California
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.
Medical Director - PSCCR Commercial Business
Responsible for the administration of medical services for company health plans 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:
Provides guidance for clinical operational aspects of the program. Conduct peer clinical and appeal case reviews. Conduct peer-to-peer discussions with attending physicians or other ordering providers to discuss review determinations,
Supports the medical management staff ensuring timely and consistent responses to members and providers.
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.
Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on internal and/or external committees.
M.D. or D.O.
Must possess an active unrestricted medical license to practice medicine in the state of residence.
Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed.
10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
Strong oral, written and interpersonal communication skills, problem-solving skills, and analytical skills.
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.
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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.