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Medical Director Rehabilitative Medicine - AIM Chicago - 139106 in Chicago, IL at Anthem, Inc.

Date Posted: 2/11/2018

Job Snapshot

Job Description

This position will be located at AIM's corporate office located in Chicago IL, near O'Hare Airport.  

Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies,  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.  

The Medical Director is responsible for ensuring the clinicintegrity of the Rehabilitative Medicine AIM solution, making sure theprogram improves the appropriateness of care, improves patient outcomes andreduces cost.  The Rehabilitative Medicine solution will cover Physical Therapy, Occupational Therapy, Speech Therapy, Chiropractic care, as well as cardiac and pulmonary rehab.  The Medical Directorleads the clinical development of the solution, including the overall strategicapproach, program design, and clinical underpinnings (clinical evidenced basedguidelines that are the foundation for the interventions which will be made byAIM on behalf of its clients.)  TheMedical Director contributes to program innovation and evolution over time toincrease efficiency and impact.

The Medical Director participates in sales meetings withprospective clients (including preparation, value estimate assessment and,input on the characteristics of the local medical market) as theprogram/solutions clinical expert.  Thiswill also include meetings with prospects’ clinical leadership to ensure theyunderstand the clinical basis for the solution.   The Medical Director supports the completionof RFIs and RFPs and other sales activities as needed to support the growth in(membership and revenue) of the solution.   

The Medical Director supports client implementations and isa key member of the team supporting the client and in particular the client’sclinical leadership after implementation. This includes developing provider acceptance and support, answeringclinical questions regarding the program, participating in conversations withthe client’s key provider partners, as well as state specialty societies andother medical organizations and institutions. 

The Medical Director acts as the key clinical leadersupporting the call center clinical teams with respect to his or her solution.  He or she is also involved in evaluating thesolutions performance regarding impact and helping to analyze expected versusactual and the causes for any discrepancies. This includes synthesizing feedback from providers received directly,through the call center and through our clients to identify opportunities forimprovement from an ease of use perspective and from and impact perspective. 

Primary duties may include but are not limited to:
  • Provide the clinical expertise necessary tocreate a clinical, evidenced based program to improve appropriateness of careand reduce cost in the Rehabilitative Medicine clinical domain.
  • Work collaboratively with the Clinical Contentand Authoring Team, the Solutions Team and Operations, to bring the conceptual“program” to reality
  • Support sales team and client executives withsales and client management activities as needed and be a clinical resource forthem as well as our clients
  • Participate as a member of the CSSDS teamsupporting the other members in their efforts and activities as possible
  • Monitor competitors’ products, emergingcompanies and technologies as sources of ideas for innovation and improvement.
  • Collaborate with others to continually driveinnovation and improvement that support greater value and ease ofimplementation and use.
  • Stay abreast of clinical developments andadvances in the specific domain and ensure that as appropriate they areincorporated into AIM’s solution.
  • Ability to represent the public face of thesolution by interacting with professional societies, patient advocacy groups,government agencies, and the press and lay public as needed in collaborationwith AIM marketing and communications.
  • Ability to represent the public face of thesolution by interacting with professional societies, patient advocacy groups,government agencies, and the press and lay public as needed in collaborationwith AIM marketing and communications

About AIM Specialty Health:

AIM Specialty health (AIM) is a leading specialty benefitmanagement company that promotes appropriate, safe and affordable healthcareservices.  We are a member of the Anthemfamily of companies, which is recognized as one of the nation’s leading healthbenefits companies.

AIM provides innovative clinical solutions that focus ontoday’s most complex and costly tests and treatments in radiology, cardiology,medical and radiation oncology, specialty drugs, sleep medicine,musculoskeletal and pain management, genetic testing, palliative care, andother emerging clinical areas.  

With evidence-based medicine, technology, people, andprocesses, we support clinical appropriateness review, provider collaboration,and member engagement on behalf of more than 50 health plans, 40% of theFortune 50 Employers, and 43 million members.

Today our team includes more than 1,100 associates andfeatures more than 600 licensed and board-certified physicians, nurses andother healthcare professionals who engage with more than 330,000 health careproviders across the country.  Thesehealthcare providers access our solutions and specialized clinical expertisethrough our online Provider Portal and experienced contact center-based teamsthat are enabled by our business platform.

Our pioneering spirit and dedication to improve health carecontinue to produce significant industry-first advancements, qualityrecognition achievements, and high user satisfaction rates.  AIM is certified by the National Committeefor Quality Assurance (NCQA) and has received full accreditation for HealthUtilization Management from the Utilization Review Accreditation Commission(URAC.)

Job Requirements

The qualified candidate will have:
  • Medical Doctor currently licensed and boardcertified in Rehabilitative Medicine by the American Board of Physical Medicine and Rehabilitation.
  • A minimum of 12 years of healthcare experience,with at least 5 years of relevant clinical experience.  Utilization management, case management, utilizationreview, or health care management experience helpful but not required
  • Experience in clinical coding (ICD-10, CPT,etc.), experience in medical informatics, and EMR experience all helpful butnot required.
  • Requires experience with population or segmenthealth management and the education and coaching of members on wellness,prevention, and healthy lifestyles.
  • Knowledge of leading competitive productofferings in the healthcare industry and marketplace standards and knowledge ofNational Accounts expectations required.
  • Demonstrated ability to work collaborativelywith other clinicians and non-clinicians
  • Demonstrated experience and effectiveness inmotivating and mentoring others who are in a direct reporting relationship
  • Ability to communicate effectively in writing,orally and with others to assimilate, understand and convey information in a mannerconsistent with job functions.  Prepareclear and concise reports, correspondence, thought leadership pieces and otherwritten materials.
  • Demonstrated ability to deliver effectivepresentations to all size groups
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.