Medical Director - California

Anthem, Inc. Woodland Hills , CA 91367

Posted 2 months ago

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 benefits companies and a Fortune Top 50 Company.

Full-time Medical Director - Woodland Hills, CA (Remote Work Available in CA)

Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost-effective medical care is received and for the day-to-day management of medical management staff.

Primary duties may include, but are not limited to:

  • 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.

  • 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 the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.

  • Supports the medical management staff ensuring timely and consistent responses to members and providers.

Qualifications

  • M.D. or D.O required.

  • Board certification approved by the American Board of Medical Specialties required.

  • Must possess an active unrestricted medical license to practice medicine in the state of CA.

  • 5 years of clinical experience or any combination of education and experience, which would provide an equivalent background required.

  • Internal Medicine, Family Practice, Emergency Medicine Board Specialty preferred. Other specialties will be considered.

  • 1 - 3 years UM, managed care experience preferred.

  • Ability to travel to Anthem's Woodland Hill office periodically for team meetings highly preferred.

  • Position requires candidates to reside in CA.

  • Ability to work PST hours with some on-call weekend coverage required.

  • 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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2019 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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Medical Director - California

Anthem, Inc.