Anthem Medical Director - Remote (PS4540) in Hesperia, California

/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 willdrive 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 benefits companies and a Fortune Top 50 Company.

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 Medicare business unit.

Primary duties may include, but are not limited to:

  • Evaluates requests for service coverage for medical necessity
  • Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
  • Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
  • Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
  • Identifies and develops opportunities for innovation to increase effectiveness and quality.
  • Serves as a resource and consultant to other areas of the company.
  • May chair or serve on company committees.
  • May be required to represent Anthem to external entities and/or serve on external committees.

  • Requires MD; or DO

  • 5 years clinical experience
  • 10 years of experience with extensive managed care or Medicare knowledge; or any combination of education and experience, which would provide an equivalent background
  • ABMS Board certification required
  • Internal Medicine, Emergency Medicine, and/or Family Practice Board Certification preferred.
  • Previous UM/appeals experience preferred.
  • Medicare experience strongly preferred
  • Medicaid and Part "D" experience desired
  • 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

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran/

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Medical Director - Remote (PS4540)

Location: california-Hesperia

Requisition ID: PS4540