Anthem, Inc. Plan Performance Medical Dir in Eagan, Minnesota
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.
We are hiring for a Plan Performance Medical Director. Responsible for serving as the lead clinician for a plan. Responsible for the administration of medical services for company health plan including the overall medical policies or clinical guidelines of the plan to ensure the appropriate and most cost-effective medical care is received. Drives direction of the plan related to cost of care and other plan directives. Works with the market plan president during meetings with State Regulator.
Primary duties may include but are not limited to:
Supports the Medical Management staff 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.
Interprets existing policies or clinical guidelines 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 efficient and effective care.
Identifies and develops opportunities for innovation to increase effectiveness and quality.
Provides expertise, captures and shares best practices across regions to other medical directors.
May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
Requires M.D. or D.O.
Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed
Requires 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.
- Anthem, Inc. Jobs