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Medical Director Associate - PS 7646 -   (Cerritos, CA location - Office based - not remote) in Los Angeles, CA at Anthem, Inc.

Date Posted: 7/8/2018

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.
Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group.  The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.
Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities and supporting the SR Medical Officer in ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality. 
Primary duties may include, but are not limited to:
  • Provides support to clinicians in daily tasks and ensuring timely and consistent medical determination responses to members and providers, conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary. 
  • May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
  • Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees, and 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.
  • 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……
  • 5+ years of clinical experience or any combination of education and experience, which would provide an equivalent background.
  • In-depth knowledge of Medicare and dually-eligible Medicare-Medicaid populations is strongly preferred. 
Please note,  we currently have one opening for this position which MUST be located in our Cerritos, CA office location.    This is not a remote position. 
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  An Equal Opportunity Employer/Disability/Veteran