Anthem, Inc. Behavioral Health Medical Director - Medicare (PS36943) in West Des Moines, Iowa
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
Location: This position will allow you to work from your home office anywhere in the United States.
This Behavioral Health Medical Director will be supporting our Behavioral Health Medicare Business and is 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. 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.
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 utilization management and case management staff ensuring timely and consistent responses to members and providers.
Works closely with physical health Medical Directors.
Must have active ABPN (American Board of Psychiatry and Neurology) certification in Psychiatry.
Must possess an active unrestricted medical license to practice medicine in the state of residence.
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
Managed Care experience strongly preferred.
Utilization Management experience strongly preferred.
Knowledge of Medicare guidelines a plus.
Experience with addiction and substance use disorders preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Ability to work as part of a matrixed, multi-disciplinary team.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
- Anthem, Inc. Jobs