Anthem

SHIFT: Day Job SCHEDULE: Full-time We are currently seeking a versatile Board Certified Physicians to participate in pre-authorization reviews of high-tech diagnostic imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology and sleep management requests using clinical guidelines and health plan medical policy. Location: Remote, anywhere in US Successful candidates will: Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging. Imaging modalities include CT, CTA, MRI, MRA, PET, and Nuclear Cardiology. Determine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy. Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of care as...