Description
SHIFT: Day Job
SCHEDULE: Full-time
Location: Remote
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?
Build the Possibilities. Make an extraordinary impact.
Responsible for providing day-to-day guidance, support, and leadership for IngenioRX (Pharmacy) under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review.
How you will make an impact:
Participates in a physician on-call rotation for a 24x7 unit.
May provide clinical guidance for programs.
Supports clinicians to ensure 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, and patients' office visits with providers and external physicians.
May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Under direction, may be responsible for the administration of medical services for company health plans including medical policies.
Serves as a resource and consultant to other areas of the company.
May interpret existing medical policy.
May be required to represent the company to external entities and/or serve on internal and/or external committees.
Qualifications
Minimum Requirements:
Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
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.
Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Must be willing to work on a rotation supporting a 24X7 operation.
Weekend work will be required, averaging every 8th weekend and rotating holidays.
Must be willing/able to work outside of standard hours to complete daily case load.
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.com for assistance.
REQNUMBER: PS71836-US
