Medical Director - Remote

<strong>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&rsquo;s a powerful combination. It&rsquo;s 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 drive the future of health care.</strong>

Houston, TX

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


Overview: This is an exceptional opportunity to do innovative work that means more to you and those we serve. <br /><br />This position supports Medicaid members in Texas and some neighboring states as needed. <br /><br />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 of the Medicaid business unit.
Responsibilities: <p style="font-weight: 400;">Primary duties may include, but are not limited to:</p> <ul style="font-weight: 400;"> <li style="font-weight: 400;">Evaluates requests for service coverage for medical necessity</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</li> <li style="font-weight: 400;">Must possess an active unrestricted medical license to practice medicine issued by state of residence</li> <li style="font-weight: 400;">10 years of experience; or any combination of education and experience, which would provide an equivalent background</li> <li style="font-weight: 400;">ABMS Board certification required</li> <li style="font-weight: 400;">Internal Medicine, Pediatrics, Family and Emergency Medicine preference<span style="font-weight: 400;">&nbsp;&nbsp;</span></li> <li style="font-weight: 400;">Previous UM/appeals experience preferred</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>