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Medical Director - ME License Required

Location: , ME
Job Family: Medical
Req #: PS45971-Maine
Date Posted: Mar 24, 2021

Description

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.

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.

Medical Director - ME License Required. Candidates must be able to travel to our office in Portland, ME. 

Responsible for the administration of medical management services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies of the Commercial business unit. Will be reporting to the Director of Medical Operations.

Primary duties may include, but are not limited to:

  • Evaluates requests for service coverage for medical necessity.

  • 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.

  • Supports the Medical Management staff ensuring timely and consistent responses to members and providers.

  • 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.

  • Expected to represent Anthem to external entities and/or serve on external committees.

 

Qualifications

  • M.D. or D.O. required, 
  • An active unrestricted ME state license required.
  • ABMS Board certification required.
  • 5 years clinical experience or any or any combination of education and experience, which would provide an equivalent background.
  • Previous UM/appeals experience preferred.
  • Managed care background required. 
  • Occasional travel in the state of ME for meetings with regulators required. 
  • Must reside within driving distance from Portland, ME. 
  • Strong communication and presentation skills required. 
  • Experience interacting with external and internal stakeholders highly preferred. 

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. 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 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.

 

 

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