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Anthem, Inc. Orthopedic Surgery Medical Director - Appeals in Las Vegas, Nevada

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

We are hiring for an Orthopedic Surgery Medical Director - Appeals. This role is responsible for the administration of 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:

Appeals Reviews

Conducts clinical reviews with attending physicians or other providers to discuss appeals determinations

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

Provides guidance for clinical operational aspects of a program

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

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

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

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.

REQNUMBER: PS40115

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