Medical Director - Albany office based

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.

Albany, NY

Anthem, Inc.

<div id="wrapper"> <div id="contentArea"> <div class="mainContent_leftrightCol"> <div class="content_Main"> <p class="Default" style="margin: 0px 0in; padding-top: 0px; padding-bottom: 0px;">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.</p> </div> </div> </div> </div>

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Overview: 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 benefits companies and a Fortune Top 50 Company.<br /> <p style="font-weight: 400;"><span style="font-weight: 400;">This is a full time salaried position that may be located in Anthem's Albany office. The team works across time zones so flexibility in hours worked is needed. Limited travel.&nbsp;</span><span style="font-weight: 400;">Responsible for providing day-to-day guidance, support, and leadership for the clinical and quality activities of nursing utilization and case management teams. The Medical Director ensures the clinical integrity of broad and significant clinical programs, and identifies and develops opportunities for innovation to increase effectiveness and quality.&nbsp;</span></p>
Responsibilities: <p style="font-weight: 400;"><span style="font-weight: 400;">Primary duties may include, but are not limited to:&nbsp;</span></p> <ul style="font-weight: 400;"> <li style="font-weight: 400;"><span style="font-weight: 400;">Provides support to clinicians in daily tasks and ensuring timely and consistent responses for review determinations to members and providers; conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations as necessary; and interacting with clinicians to ensure timely and quality care for plan members.&nbsp; </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy, and technology assessments, setting and implementing QI initiatives.&nbsp;</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The medical director may be required to provide clinical expertise in sales planning and participates in the acquisition and retention of client. </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Provides input on the clinical relevance of account reporting regarding use of medical services by members.&nbsp; </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Also will be involved in identifying and managing medical utilization trends and for proactively identifying and formulating solutions with Account Management/sales RVP Medical Directors.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Serves as a resource and consultant to other areas of the company and may be required to represent the business unit to internal or external entities. </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">This may involve account facing activities so presentation and speaking ability is a plus.</span></li> </ul>
Requirements: <ul style="font-weight: 400;"> <li style="font-weight: 400;"><span style="font-weight: 400;">Needs to function well on a team of physicians and other health professionals.</span></li> <li style="font-weight: 400;">Requires M.D. or D.O. Current Board certification approved by the American Board of Medical Specialties required (ABMS)</li> <li style="font-weight: 400;">Must possess an active unrestricted medical license to practice medicine in NY&nbsp;</li> <li style="font-weight: 400;">At least 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.&nbsp;</li> <li style="font-weight: 400;">2 years of experience with utilization review preferred. Prior use of medical management systems is valued.</li> <li style="font-weight: 400;">Knowledge and experience with population or segment health management is a plus.</li> <li style="font-weight: 400;">Knowledge of health insurance industry and the National Accounts segment is also a plus.</li> <li style="font-weight: 400;">Must be a team player, collaborative and capable of independent work.</li> <li style="font-weight: 400;">Ability to work in Anthem&rsquo;s Albany office&nbsp;</li> </ul>