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Mgr. Medical Director-Medicaid (PS3036) in Eagan, MN at Anthem, Inc.

Date Posted: 7/23/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we’re creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.
 
Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program.

 
Responsible 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:
 
 
  • Serves as primary medical liaison with BCBSMN for areas of medical policy and clinical management to ensure effective communication and collaboration.
     
  • 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.
 
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff.
  • 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 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 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.  An Equal Opportunity Employer/Disability/Veteran