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Anthem, Inc. CareMore Medical Director in Reno, Nevada

Description

SHIFT: Day Job

SCHEDULE: Full-time

CareMore and Aspire Health are entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 200,000 patients in 30+ states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. Primary duties may include, but are not limited to:

  • Supports clinicians to ensure timely and consistent responses to members and providers.

  • Provides guidance for clinical operational aspects of a program.

  • Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.

  • May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

  • Serves as a resource and consultant to other areas of the company.

  • May be required to represent the company to external entities and/or serve on internal and/or external committees.

  • May chair company committees. Interprets medical policies and clinical guidelines.

  • May develop and propose new medical policies based on changes in healthcare.

  • Ability to work Monday to Friday 8am to 5pm Pacific Time

  • 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.

Qualifications

  • Requires M.D. or D.O.;

  • Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed, Must possess an active unrestricted medical license to practice medicine or a health profession.

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

  • For Clinical Solution Team (CST) organization (including Behavioral Health) only, 5 years of experience providing health care is required. 10 years of clinical experience does not apply. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 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.

REQNUMBER: PS41152

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