Medical Director - Washington State Remote/ Seattle preferred

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.

Seattle, WA

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. https://antheminc.com/index.htm

keywords: administration,medical,compliance,quality assurance,consulting,medical,legal,experience,certification

Experienced

Overview: Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff. 
Responsibilities: <strong>Primary duties may include, but are not limited to:</strong> <ul> <li>Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.</li> <li>Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.</li> <li>Identifies and develops opportunities for innovation to increase effectiveness and quality.</li> <li>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 external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.</li> <li>Supports the medical management staff ensuring timely and consistent responses to members and providers.&nbsp;</li> </ul>
Requirements: <ul style="font-weight: 400;"> <li style="font-weight: 400;">Requires M.D. or D.O.&nbsp;</li> <li style="font-weight: 400;">Current ABMS Board certification&nbsp;</li> <li style="font-weight: 400;">Must possess an active unrestricted medical license to practice medicine in State of Washington&nbsp;</li> <li style="font-weight: 400;">At least 10 years of clinical experience or any combination of education and experience&nbsp;</li> <li style="font-weight: 400;">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</li> </ul>