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Anthem, Inc. Provider Performance Medical Director - Oklahoma (Remote) in Oklahoma

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.

This position will be supporting our Medicaid Business in the state of Oklahoma.

Primary duties may include, but are not limited to:

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

  • Interprets medical policies and clinical guidelines.

  • Responsible for the provider performance program enterprise wide by persuading physician groups, local markets and medical staff of the value of the program for members improved quality of care, lower cost of services and improved financial reimbursement for providers who are successful in managing quality, access and overall costs.

  • Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits with providers and external physicians.

  • Conducts peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.

  • Engages with providers in joint operating committees and builds relationships with clinical leadership of provider collaboration groups.

  • Responsible for developing and implementing programs to improve quality, cost, and outcomes.

  • Provides clinical consultation and serves as clinical/strategic advisor to enhance clinical operations.

  • Accountable for achieving performance results in value based care by engaging, influencing and supporting physicians.

  • Supports clinicians to ensure timely and consistent responses to members and providers.

  • Provides guidance for clinical operational aspects of a program.

  • Designs and develops national level interventions leveraging existing tools that will drive performance in value based care.

  • Provides expertise, captures and shares best practices across regions to provider partners as well as Anthem medical directors.

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

  • Works with the Care Delivery Transformation team to develop and deliver high impact field interventions, supporting content development and practice transformation embedded capabilities improving provider performance.

  • Influences and partners with local market medical and financial leadership to ensure appropriate level of focus on performance of providers in the program.

  • Collaborates with Provider Enablement leadership team to bring insight, innovation and opportunities that help drive performance.

  • Drives strategies around cost of care and analytic tools and reporting.

  • Develops understanding of value based contracts across lines of business in a region.

Additional duties may include, but are not limited to:

  • 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.

  • 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.

Qualifications

  • This position will be located in the state of OK. Candidate must reside in OK or be willing to relocate (relocation assistance may be available).

  • M.D. or D.O.

  • Board certification approved by the American Board of Medical Specialties required.

  • Board certified in Internal Medicine, Family Medicine, Emergency Medicine, Pediatrics, OBGYN strongly preferred.

  • Active unrestricted medical license to practice medicine in state of OK or ability to acquire OK licensure required.

  • 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

  • 1-3 years of experience with utilization review/ managed care background a plus.

  • 5+ years of managerial/leadership experience highly preferred.

  • 30% travel in the state of OK may be required.

  • MBA, MHA or MPH degree preferred.

  • Strong communication, interperonal skills, and presentation skills required.

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.

REQNUMBER: PS38770-Oklahoma

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