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Manager Medical Director-(Medicaid)-PS2904 in West Des Moines, IA at Anthem, Inc.

Date Posted: 3/14/2018

Job Snapshot

Job Description

Your 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.

Mgr. Medical Director (Medicaid)

Responsible for the administration of Medicaid 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 to include; Case Management (CM) and Utilization Management (UM) and Medicaid Managed Long Term Services and Supports (MLTSS).
  • 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.
  • The incumbent will be an important part of the health plans senior management team and most have a range of experience, expertise and interest to meaningfully participate in the broad range of activities that the management team faces.  The scope of these activities includes subjects beyond what would be narrowly defined as clinical in nature. 
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff.

Job Requirements

  • 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.
  • Extensive Medicaid Medical Management experience strongly 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, and 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background

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 EOE. M/F/Disability/Veteran.