Anthem, Inc. Associate Medical Director or Medical Director - AIM Specialty Health in Coconut Grove, Florida
SHIFT: 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.
We are currently seeking several versatile Board Certified Medical Oncologists to participate in pre-authorization reviews related to oncology care. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cancer chemotherapy and genetic testing requests using clinical guidelines and health plan medical policy.
Location: This position has been approved to work remote, anywhere in the US with preference given to candidates located in California.
Successful candidates will:
Perform physician-level case review, following initial nurse review, of radiation therapy regimens and supportive care.
Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging. Imaging modalities include CT, CTA, MRI, MRA, and PET.
Determine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy.
Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.
Demonstrate and maintain current knowledge of new cancer treatment regimens.
As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
Participate in periodic physician team meetings.
Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.
Perform first level provider appeals as designated by the client for adverse determinations.
Obtain additional state licensure based upon business needs.
Adhere to all AIM Specialty Health Management protocols, policies, and procedures.
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine
Board Certification by American Board of Medical Specialties
Preferred criteria in addition to requirements:
Board certification in Medical Oncology or Radiation Oncology.
Min of 3 years of clinical experience post fellowship training
Demonstrated knowledge of current practice standards in oncology.
Strong oral communication and interpersonal skills.
Intermediate computer skills (including MS Office and Outlook), ability to learn new applications.
Strong analytical skills.
Ability to multi-task.
Ability to work both independently and in a team environment.
Ability to work in a dynamic, fast-paced environment.
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. 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. 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.