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Medical Director - Appeals

Job Family: Medical
Req #: PS41008
Date Posted: Dec 1, 2020


SHIFT: Day Job

SCHEDULE: Full-time

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 will drive the future of health care.

We are hiring for a Medical Director - Appeals. 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 care companies and a Fortune Top 50 Company.

Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received.

May be responsible for developing and implementing programs to improve quality, cost, and outcomes.

May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.

May identify cost of care opportunities.

May serve as a resource to staff including Medical Director Associates.

May be responsible for an entire clinical program.

Primary duties may include, but are not limited to:

Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program.

Serves as a resource and consultant to other areas of the company.

May be required to represent the company to external entities and/or serve on internal and/or external committees.

May chair company committees. Interprets medical policies and clinical guidelines.

May develop and propose new medical policies based on changes in healthcare.

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.

Conducts peer-to-peer appeal reviews with joint venture physicians as needed


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.

Medicare Review or Appeals experience preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

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