myNEXUS Clinical Operations Medical Director- UM

  • Anthem
  • Remote
  • May 15, 2022
Physician Family Medicine Geriatric Medicine Internal Medicine PM&R

Job Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? 

A proud member of the Anthem Inc family of companies, myNEXUS is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.

Job Summary:

Responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.

Primary duties may include, but are not limited to:

  • Ensures timely completion of clinical case reviews for post-acute care.
  • Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested.
  • Ensures consistent use of company medical policies when making medical necessity decisions.
  • Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation.

Qualifications

Minimum Requirements:

  • Requires an MD or DO Degree
  • Minimum of 1 year of experience with clinical case reviews for medical necessity or minimum of 3 years of clinical expereince in inpatient post-acute care
  • Board Certification in medical specialty. Internal Medicine, Geriatrics, Family Medicine, or Physiatry are preferred. 
  • This job is paid on an hourly basis.


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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.comfor assistance.