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RVP Medical Director-Central Region- PS10953 in Mason, OH at Anthem, Inc.

Date Posted: 11/30/2018

Job Snapshot

Job Description

Responsible for administration of the company health plan medical services to ensure the appropriate and cost effective medical care is provided for Anthem's 7-state central region for Medicare. Oversees medical performance for assigned health services area and clinical decision-making aspects of programs. 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.
  • This individual will be responsible for managing the clinical operations in the Central Region.
  • Will be accountable for State, Quality,UM,CM,revenue, provider relations and compliance. 
  • Supports the Medical Management staff ensuring timely and consistent responses to members and providers. 
  • Identifies and develops opportunities for innovation to increase effectiveness and quality. 
  • Serves as a resource and consultant to other areas of the company. 
  • Serves on company committees. 
  • Represents company to external entities and/or serves on external committees. 
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requires MD; board certification approved by the American Board of Medical Specialties where applicable to duties being performed; 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Medicare business knowledge is desired, Government business experience highly preferred.