Anthem Medical Director - Remote - Houston Pref. (PS9481) in Des Moines, Iowa

Medical Director - Remote - Houston Pref. (PS9481)

New

Location: Houston, Texas, United States

Field: Medical

Requisition #: PS9481

Post Date: Jul 12, 2018

Your Talent. Our Vision. At Amerigroup , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.

This position supports Medicaid members in Texas

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 theaid 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

  • Must possess an active unrestricted medical license to practice medicine issued by state of residence

  • 10 years of experience; or any combination of education and experience, which would provide an equivalent background

  • ABMS Board certification required

  • Internal Medicine, Pediatrics, Family and Emergency Medicine preference

  • Previous UM/appeals experience 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 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran .