Medical Director/ Medical Director Associate - Office based Andover, MA

<em>Your Talent. Our Vision.</em><strong>&nbsp;At Anthem, Inc.,&nbsp;</strong>it&rsquo;s a powerful combination, and the foundation upon which we&rsquo;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&nbsp;<strong>drive the future of health care</strong>.

Andover, MA

Anthem Inc.- Health Solutions

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.

keywords: innovation,administration,management,compliance,quality assurance,analysis,travel,medical,management,experience,travel,certification


Overview: <p style="font-weight: 400;">This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.</p> <p style="font-weight: 400;"><u style="font-weight: 400;">Medical Director/Medical Director Associate&nbsp;</u></p> <p style="font-weight: 400;">Responsible for the administration of medical management services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies. &nbsp;</p>
Responsibilities: <p style="font-weight: 400;"><strong>Primary duties may include, but are not limited to:</strong></p> <ul style="font-weight: 400;"> <li style="font-weight: 400;">Provide clinical case management leadership to multidisciplinary team including: Nurses, Pharmacists, Social Workers, Dietitians and specialty roles. &nbsp;</li> <li style="font-weight: 400;">Evaluates requests for service coverage for medical necessity</li> <li style="font-weight: 400;">Interacting with hospital based physicians with limited travel.&nbsp;&nbsp;</li> <li style="font-weight: 400;">Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.</li> <li style="font-weight: 400;">Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.</li> <li style="font-weight: 400;">Supports the Medical Management staff ensuring timely and consistent responses to members and providers.</li> <li style="font-weight: 400;">Identifies and develops opportunities for innovation to increase effectiveness and quality.</li> <li style="font-weight: 400;">Serves as a resource and consultant to other areas of the company.</li> <li style="font-weight: 400;">May chair or serve on company committees.</li> <li style="font-weight: 400;">May be required to represent Anthem&nbsp;to external entities and/or serve on external committees.</li> </ul>
Requirements: <ul style="font-weight: 400;"> <li style="font-weight: 400;">Requires MD; or DO in State of MA&nbsp;<span style="font-weight: 400;">&nbsp;</span></li> <li style="font-weight: 400;">5 years of clinical experience</li> <li style="font-weight: 400;">ABMS Board certification required</li> <li style="font-weight: 400;">Internal Medical, Emergency, Family Medicine Board Certification preferred</li> <li style="font-weight: 400;">Hospitalist, UM, Case Management/Population Health background preferred</li> <li style="font-weight: 400;">10% local travel in state of MA required</li> </ul>