Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities and supporting the Medical Director in ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality. Primary duties may include, but are not limited to:
Provides support to clinicians in daily tasks and ensuring timely and consistent responses to members and providers, conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary.
May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees, and 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.
Requires M.D. or D.O.;
Requires Board certification approved by the American Board of Medical Specialties
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
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
Title: Psychiatrist Medical Director or Medical Director Associate - 119040 - Part Time or Full Time
Other Locations: IA-Des Moines
Requisition ID: 119040 3c3a9c5584f7415d9fc6bb55fde7b03a
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