Anthem Medical Director/Medical Director Associate - Florida Remote (PS4907) in Green Valley, Arizona
Medical Director/Medical Director Associate - Florida Remote (PS4907)
Location: United States
Requisition #: PS4907
Post Date: 1 day ago
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.
This position supports the Simply Health Care Plans of Florida.
**Location for this position is within the State of Florida, work at home will be considered.**
Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities and supporting the Medical Director in ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality. Primary duties may include, but are not limited to:
Provides support to clinicians in daily tasks and ensuring timely and consistent responses to members and providers, conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary.
May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees, and 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.
Requires M.D. or D.O
Must possess an active unrestricted medical license to practice medicine in the State of Florida.
Current Board Certification approved by the American Board of Medical Specialties required
5-10 years post resident clinical experience required
Florida resident required
Managed care background preferred
Medicare/ Medicaid background preferred
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 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.