Associate Medical Director or Medical Director - Oncology

Company: Anthem, Inc.
Location: Bozeman
Posted on: January 9, 2022

Job Description:

Associate Medical Director or Medical Director - Oncology 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 and Radiation 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: 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. Qualifications Qualified Candidates will have:
  • Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine
  • Board Certification by American Board of Medical Specialties in Medical Oncology or Radiation Oncology.
  • 3-5 years of clinical practice experience past fellowship training is desirable.
  • 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 environ 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. 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. EEO is the Law
    EqualOpportunityEmployer/Disablity/Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance. *WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the 'Rip-offs and Imposter Scams' option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., Bozeman , Associate Medical Director or Medical Director - Oncology, Executive , Bozeman, Montana