Anthem, Inc. Medical Director in Melville, New York
SHIFT: Day Job
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.
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 care companies and a Fortune Top 50 Company.
This is a full time salaried position that can be located anywhere in the United States. Telecommuting may be considered. The team works across time zones so flexibility in hours worked is needed. Limited travel.
The medical director will be responsible for supporting the clinical vision and implementation in order to deliver an improvement in the health of the people we serve. The medical director supports product strategy/design and medical management approaches that impact health care quality, cost, and outcomes, and improving access to the health improvement tools offered to members.
Day to day clinical responsibilities means that the medical director provides clinical oversight for Utilization Management, Case Management, and Disease Management of the Clinical Team.
Primary duties may include, but are not limited to:
Conducts case reviews for both utilization and case management issues, consistent adoption and implementation of all medical policies, leading multidisciplinary rounds, peer to peer outreach for both UM and CM issues, identifying quality issues, clinical report reviews, trend management, benefit design consultation, and supporting overall clinical performance guarantee success.
The medical director provides clinical expertise in sales planning and participates in the acquisition and retention of clients as needed.
Provides input on the clinical relevance to account reporting regarding use of medical services by members. Involved in identifying and managing medical utilization trends, emerging trends and market changes that impact the client and members.
Responsible for proactively identifying and solutioning with account management, Sales RVP Medical Directors.
M.D. or D.O required.
5 years of clinical experience and additional experience in extensive managed care knowledge (or any combination of education and experience, which would provide an equivalent background) required.
Requires a current unrestricted medical licensure in any US applicable state(s).
Current and active Board Certification approved by the Americal Board of Medical Speciatries (ABMS) required. Family Practice or Internal medicine preferred. Other specialites will be considered.
Knowledge and experience with population or segment health management is a plus.
Knowledge of health insurance industry and the National Accounts segment a plus.
Must be a team player, collaborative and capable of independent work.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
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