Medical Director Associate - Medical Oncology - AIM Specialty Health
DescriptionSHIFT: Day Job
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater 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.
Location: Remote/Hybrid role; anywhere in the US, but near an Anthem office preferred
Responsible for leading physician efforts in supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Primary duties may include but are not limited to:
- Provides oversight to physicians and ensures timely completion of clinical case reviews for their board-certified specialty.
- Ensures consistent use of company medical policies when making medical necessity decisions.
- Educates and provides direct medical coverage decision support as needed for team of physician advisors.
- Ensure system integrity in alignment with all relevant clinical criteria as related to sources which include client medical policy, compendia alignment, pathway requirements, and CMS guidance
- Interpret and provide feedback on client medical policy
- Provide oversight for clinical integration during implementations, clinical updates, and any system clinical change requirements
- Provide clinical direction for new oncology program expansions
- Participate in AIM Clinical Pathway development and system implementations
- Develop and/or support workflow and best practices for clinical integration processes
- 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.
- Board Certified in Medical Oncology
- Strong computer skills (MS Office, Outlook)
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 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. 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 race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.