SHIFT: Day JobSCHEDULE: Full-timeYour 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 care companies and a Fortune Top 50 Company.Behavioral Health Medical DirectorResponsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff.
Primary duties may include, but are not limited to: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.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 the company to external entities and/or serve on external committees, 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, provides guidance for clinical operational aspects of the program.Supports the medical management staff ensuring timely and consistent responses to members and providers.
Additional Duties Include:Assists in managing medical costs and assuring appropriate health care deliveryProvides Medical and Behavioral Health guidanceSupports Medical Director(s) in all aspects of coordination of care, quality and network management and pharmacy management.Coordinates care and services with respective Georgia State Foster Care Government Agencies and DepartmentsAssists Medical Directors and/or National Medical Directors with medical policy; participates in policy review, reviews trends and makes recommendations; may plan, organize and/or direct medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.Assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance.Supports URAC and NCQA qualification activities.
Prepare for site visits and responds to accrediting and regulatory agency feedback.Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.Participates in the development of strategic planning for existing and expanding business.
Recommends changes in program content in concurrence with changing markets and technologies.QualificationsM.D.
or D.O.Current and active board certification in PsychiatryAn active unrestricted license to practice medicine5 years of clinical experience or any combination of education and experience, which would provide an equivalent backgroundUnless 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 Preferred:Geriatric PsychiatryMaster’s in Public Health, MBA or experience in public healthTwo years in medical management/health administration in a managed care environmentWe offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Anthem, Inc.
has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes.
To learn more about our company and apply, please visit us at careers.Antheminc.Com.
An Equal Opportunity Employer/Disability/Veteran.
Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.