The Medical Director 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 and for the day-to-day management of medical management staff.
Primary duties may include, but are not limited to:
Applies existing policies and guidelines for medical necessity reviews for services for Medi-Cal beneficiaries.
Conducts peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations
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.
Participate in meetings with provider groups to address audits, performance reporting or collaborative projects.
Be involved in local community activities as a representative of Anthem
Supports the medical management staff and other business units ensuring timely and consistent responses to members and providers.
Provide and participate in clinical team training, audits and quality improvement activities
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.
Must be licensed and reside in California
Ability to be OPW (Off Premise Worker)
Preferably based in the Bay Area or Northern CA
Willing to travel occasionally
Primary Care Specialty preferred
Experience with medical group or county health services administration preferred
UM or medical group management experience preferred
/Anthem, Inc. is ranked as one of America?s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.__/
Title: Medical Director, California 122643
Other Locations: CA-San Francisco, California
Requisition ID: 122643 cd24fabc92b14326a21dbaa3427dca23
We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.
Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company. At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans.
- One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
- We offer a broad range of medical and specialty products.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.
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 co