Medical Director / Medical Director Associate - Remote Central and Northern CA

<em>Your Talent. Our Vision.</em><strong>&nbsp;At Anthem Blue Cross</strong>, a proud member of the Anthem, Inc. family of companies,&nbsp;<strong>&nbsp;</strong>it&rsquo;s a powerful combination, and the foundation upon which we&rsquo;re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will&nbsp;<strong>drive the future of health care</strong>.&nbsp;

Sacramento, CA

Anthem, Inc. - Business

Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 74 million people served by its affiliated companies, including approximately 40 million within its family of health plans, Anthem is one of the nation's leading health benefits companies.

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Overview: Responsibilities include care management, medical appropriateness reviews, and over 50% of the time representing Anthem as a clinical leader with providers, provider groups, local county officials, and hospital systems.&nbsp;&nbsp;Will work on collaborative projects around HEDIS and care coordination and help build relationships.
Responsibilities: <p style="font-weight: 400;"><strong>Primary duties include, but are not limited to:</strong> &nbsp;</p> <ul style="font-weight: 400;"> <li style="font-weight: 400;">Meet with providers and other health care stakeholders to build relationships and execute collaborative projects.</li> <li style="font-weight: 400;">Interpret and administer company medical policies and clinical guidelines.</li> <li style="font-weight: 400;">Generates appropriate written correspondence to providers, members, and regulatory entities.</li> <li style="font-weight: 400;">Working closely with clinical and non-clinical staff to ensure timely and consistent responses to members and providers.</li> <li style="font-weight: 400;">Identify and develop opportunities to increase medical management effectiveness and healthcare quality.</li> <li style="font-weight: 400;">Serves as a resource and consultant to other areas of the company including legal, compliance and medical operations</li> <li style="font-weight: 400;">Liaison with external regulators including the CA Department of Insurance and the CA Department of Managed Health Care.</li> <li style="font-weight: 400;">May chair or serve on company committees</li> <li style="font-weight: 400;">Review member grievances</li> </ul>
Requirements: <ul style="font-weight: 400;"> <li style="font-weight: 400;"><span style="font-weight: 400;">MD or DO</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Requires current, unrestricted CA license to practice medicine.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Current ABMS recognized board certification required&nbsp;</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">At least 3-5 years of post-residency clinical experience required.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">At least 3-5 years of medical utilization management experience required&nbsp;</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Requires at least an intermediate level of computer literacy</span><span style="font-weight: 400;">&nbsp;</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">A</span><span style="font-weight: 400;">bility to travel in Northern CA up to 30% required.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Demonstrated Leadership/ External client experience preferred</span>&nbsp;</li> </ul>