Associate Medical Director

  • Anthem
  • Remote
  • Nov 04, 2021
Physician Emergency Medicine Family Medicine Internal Medicine

Job Description

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 they pertain to the use of diagnostic imaging studies, cardiac testing and sleep management services.
  • Suggest alternatives services to ordering providers when appropriate.
  • Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.
  • Demonstrate and maintain current knowledge of modalities and new applications of known technologies for diagnostic imaging, cardiac services and sleep management.
  • As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered modalities.
  • Participate in periodic physician team meetings.
  • Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and sleep management.
  • Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.
  • Perform first level provider appeals as designated by the client for adverse determinations.
  • Obtain additional state licensure based upon business needs.
  • Adhere to all AIM Specialty Health Management protocols, policies, and procedures. 

Qualifications

Qualified Candidates will have:

  • Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine
  • Board Certification by American Board of Medical Specialties: Internal Medicine, Family Medicine and Emergency Medicine preferred 
  • Demonstrated knowledge of current practice standards in specialty
  • Strong oral communication and interpersonal skills
  • Computer literacy with the ability to learn new applications
  • Strong analytical skills
  • Ability to multi-task
  • Ability to work both independently and in a team environment

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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 promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.