Anthem Medical Director (Medicare Central Region) - 128381 in Lubbock, Texas
/Your Talent. Our Vision./At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.
Location: Indiana, Kentucky, Georgia, Tennessee, Missouri, Ohio, Georgia, or Wisconsin
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
10 years of experience with extensive managed care or Medicare knowledge; or any combination of education and experience, which would provide an equivalent background.
Board certification required where applicable to the duties being performed.
Previous UM/appeals experience preferred.
Internal Medicine, Emergency Medicine, and/or Family Practice Board Certification preferred.
Medicare experience strongly preferred.
Medicaid and Part "D" experience desired.
/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 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./
Title: Medical Director (Medicare Central Region) - 128381
Requisition ID: 128381