Lead Medical Director - Utilization Management


Non clinical

Job Highlights

  • Fast Credentialing
  • 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.

    We are hiring for a Lead Medical Director. Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.

    Must be licensed in KY

    Primary duties may include but are not limited to:

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

    Provides guidance for clinical operational aspects of a program

    Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations

    May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations

    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.

    Interprets medical policies and clinical guidelines

    May develop and propose new medical policies based on changes in healthcare

    Requires M.D. or D.O.

    Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed

    Requires active unrestricted medical license to practice medicine or a health profession

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

    Posted February 2, 2021