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 benefits companies and a Fortune Top 50 Company.
Location: Must be willing to relocate or reside Las Vegas, NV
Responsible for the day to day medical management operations along with local quality and improvement initiatives for the State Health Plan. 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.
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 as needed, serves on company committees and 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 and supports the medical management staff ensuring timely and consistent responses to members and providers.
Requires M.D. or D.O.; board certification approved by the American Board of Medical Specialties 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 is ranked as one of America?s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us atwww.anthem.com/careers. EOE. M/F/Disability/Veteran.
Title: Medical Operations Director - MD (Las Vegas, NV) - 120972
Other Locations: NV-Las Vegas
Requisition ID: 120972 15bd723d42894a5b8f762a1db17fae3a
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