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Medical Director / Medical Director Associate  -  Remote Central and Northern CA  (PS5504) in Sacramento, CA at Anthem, Inc.

Date Posted: 6/25/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem Blue Cross, a proud member of the Anthem, Inc. family of companies,  it’s a powerful combination, and the foundation upon which we’re creating greater 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.
Medical Director/ Medical Director Associate , CA Medicaid Business
Responsibilities include care management, medical appropriateness reviews, and over 50% of the time representing Anthem as a clinical leader with providers, provider groups, local county officials, and hospital systems.  Will work on collaborative projects around HEDIS and care coordination and help build relationships.
Primary duties include, but are not limited to:  
  • Meet with providers and other health care stakeholders to build relationships and execute collaborative projects
  • Interpret and administer company medical policies and clinical guidelines
  • Generates appropriate written correspondence to providers, members, and regulatory entities.
  • Working closely with clinical and non-clinical staff to ensure timely and consistent responses to members and providers.
  • Identify and develop opportunities to increase medical management effectiveness and healthcare quality.
  • Serves as a resource and consultant to other areas of the company including legal, compliance and medical operations
  • Liaison with external regulators including the CA Department of Insurance and the CA Department of Managed Health Care.
  • May chair or serve on company committees
  • Review member grievances

  • MD or DO
  • Requires current, unrestricted CA license to practice medicine
  • Current ABMS recognized board certification required 
  • At least 3-5 years of post-residency clinical experience required
  • At least 3-5 years of medical utilization management experience required 
  • Requires at least an intermediate level of computer literacy 
  • Ability to travel in Northern CA up to 30% required
  • Demonstrated Leadership/ External client experience preferred 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.