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Behavioral Health Medical Director Associate - Full-time or Part-time - Nationwide (Remote) - PS26135Location: United StatesNewRequisition #: PS26135Your 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.Location: Nationwide (Work @ Home Available)Preferred states: MO, CA, VA, CT or proximity to a large Anthem BH office.This position will be supporting our Behavioral Health Commercial Business.Responsible for providing day to day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Director in ensuring the clinical integrity of broad and significant clinical programs. May be responsible for performing clinical reviews.For Behavioral Health organizations:Medical Director Associates work independently under the supervision of a manager and/or staff vice president. May perform clinical reviews which determine medical necessity for services. May perform quality reviews which determine if there is a quality of service concern.For Behavioral Health organizations: Medical Director Associates primarily focus on clinical case reviews and receives oversight from management (people leader). Oversight is not from a Medical Director, it is from the manager and/or Staff Vice President. Applies existing medical policies.Primary dutiesmay include, but are not limited to: May provide guidance for clinical operational aspects of a program with oversight from a Medical Director. Provides support to clinicians to ensure 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, and patients’ office visits with providers and external physicians as necessary. May conduct peer to peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. May participate in a physician on-call rotation for a 24x7 unit. May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. May be responsible for the administration of medical services for company health plans including the overall medical policies of the business unit under the direction of a Medical Director. Serves as a resource and consultant to other areas of the company. May interpret existing medical policy. May be required to represent the company to external entities and/or serve on internal and/or external committees.For Behavioral Health organizations:Primary duties may include, but are not limited to:May provide guidance for clinical operational aspects of a program with oversight from management.Provides support to clinicians to ensure timely and consistent responses to members and providers.Conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss and review clinical determinations.May conduct peer to peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.May participate in a physician on-call rotation for a 24x7 unit.May be responsible for the administration of medical services for company health plans including the overall medical policies of the business unit under the direction of management.Serves as a resource and consultant to other areas of the company.Applies existing medical policy. Interprets clinical guidelines.May be required to represent the company to external entities and/or serve on internal and/or external committees.M.D. or D.O. required
Board certification approved by the American Board of Psychiatry and Neurology required.
Must possess an active unrestricted medical license to practice medicine.
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
Additional board certification in either child psychiatry or addiction medicine preferred.
UM review experience preferred.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Preferred states of residence are MO, CA, VA, or CT. Can be located anywhere in the U.S
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 2018 DiversityInc 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
