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Anthem, Inc Director, Medical Operations (Physician role) - Atlanta PS28641 in Indianapolis, Indiana

Director, Medical Operations (Physician role) - Atlanta PS28641

Location: Atlanta, Georgia, United States


Requisition #: PS28641

Post Date: 5 days ago

YourTalent. Our Vision. At Anthem Blue Cross and Blue Shield , a proud member of the Anthem, Inc. family of companies, 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.

DirectorMedical Operations

Location: Anthem office on 3350 Peachtree Road, Atlanta, GA

Responsible for the day to day medical management operations along with local quality and improvement initiatives for the Georgia State Health Plan. Primary duties may include, but are not limited to:


  • Interpretsexisting policies and develops new policies based on changes in the healthcareor medical arena.

  • Leads,develops, directs, and implements clinical and non-clinical activities thatimpact health care quality cost and outcomes.

  • Conductpeer clinical and/or appeal case reviews and peer to peer clinical reviews withattending physicians or other ordering providers to discuss reviewdeterminations

  • Supportsthe Medical Management staff ensuring timely and consistent responses tomembers and providers.

  • Identifiesand develops opportunities for innovation to increase effectiveness andquality.

  • Servesas a resource and consultant to other areas of the company as needed.

ProviderCollaboration and External-Facing:

  • Serveson company committees and represents Anthem to external entities and/or serveon external committees.

  • Providesexpertise, captures and shares best practices across regions to providerpartners as well as Anthem medical directors.

  • Servesas a resource and consultant to providers in a region.

  • Engageswith providers in joint operating committees and builds relationships withclinical leadership of provider collaboration groups.

Leadershipand Strategy:

  • Drivesstrategies around cost of care and analytic tools and reporting.

  • Providesguidance for clinical operational aspects of the program and supports themedical management staff ensuring timely and consistent responses to membersand providers.

  • Hires,trains, coaches, counsels, and evaluates performance of direct reports.

Requires M.D. or D.O.; board certification approved by the American Board of Medical Specialties where applicable to duties being performed; 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, and ; 10 years of clinical experience ; or any combination of education and experience, which would provide an equivalent background. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Must Have

  • ManagedCare knowledge and experience.

  • Knowledgeof healthcare delivery systems.

  • Priorexternal-facing experience orinterestin external-facing role.

  • Excellent communication and strong negotiation skillsto drive collaborative resolution.

  • Appropriate poise and polish tointeract with hospital administrators, providers, and medical practiceleadership at a high level.

  • Willing and able to travelwithin the state to meet with providers.


Familiarity with Georgia provider market.

Anthem, Inc. is ranked as one of America’s Most AdmiredCompanies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at AnEqual Opportunity Employer/Disability/Veteran.