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Mgr. Medical Director (139184) - Wise, VA #4418819


Company: Anthem

Date: 01/13/2018

Category: Insurance

City: Wise, VA

/ Your Talent. Our Vision. / At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive the future of health care.


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.


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Responsible for serving as a Manager, Medical Director for the Government Business Division (GBD) for Medicare and Medicaid. Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff. The Managing Medical Director will be responsible for medical management impact on health care quality, cost, and outcomes, and integrated behavioral and physical health services


There are two main focuses of the position.



  1. Improving the health of the people we serve in the GBD, by designing, implementing, operating and iterating the behavioral health medical management approaches to whole person health.


  2. Assuring that the GBD behavioral health medical management operations align both with the overall GBD whole person approach to health care, and also align with the Anthem overall medical management approach to behavioral health.

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.


  • Identifies and develops opportunities for innovation to increase effectiveness and quality.


  • Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, 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.


  • Supports the medical management staff ensuring timely and consistent responses to members and providers.


  • Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff.


    • Providing medical leadership * for GBD in the following areas: utilization management, behavioral and physical health integration, case management, disease management, and quality management.
  • Assuring the ongoing development of anintegrated behavioral and physical healthproduct that aligns with overall Anthem approach to integrated care and improves health outcomes.


  • Contributing to the development, implementation, operation and improvement ofMedical Management and Quality Management programs for GBD Behavioral Health.


    • Communicating * to GBD medical management and health care management the behavioral health medical management trends, and recommending, implementing, and monitoring the impact of needed interventions to address identified trends.
  • Ensuring consistentadoption and implementation of all medical policies.


  • Collaborating with heath care management leaders torefine and improve provider and medical management servicesto meet the needs of GBD.


  • Providingclinical expertisein business and product development, sales planning, and participating in the acquisition and retention of GBD accounts.


  • Assuring the clinical relevance ofreportingregarding use of behavioral health medical services by GBD members.


  • Contributing behavioral health medical leadership within GBD for provider enablement initiatives.


  • Contributing to improved relationships with providers and national associations and societies (i.e., AMA, APA).


  • Representing the company at nationally recognized speaking engagements to promote GBD programs.


  • May 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.


    Requirements:


  • Requires M.D. or D.O.; Board certification approved by the American Board of Medical Specialties required 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


  • Active ABMS recognized psychiatry board certification required. Additional board certification in either child psychiatry or addiction medicine desirable.


  • Requires significant experience and demonstrated success with behavioral health population management across GBD product types.


  • Knowledge and significant experience with integrated care operations (BH & PH) and outcomes.


  • Knowledge of and experience with Medicaid and Medicare UM.


  • Knowledge of budgeting and personnel management. Proficient data analytic and computer skills.


  • Contributing to improved relationships with providers and national associations and societies (i.e., AMA, APA).


  • Representing the company at nationally recognized speaking engagements to promote GBD program.


    / Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /


Job Medical


Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.


Title: Mgr. Medical Director (139184)


Location: virginia-Wise


Requisition ID: 139184


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