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Anthem, Inc. Behavioral Health Medical Director - KY Medicaid in Denver, Colorado

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.

Behavioral Health Medical Director - KY Medicaid

There are two main focuses of the position.

  • Improving the health of the people we serve in the Government Business Division (GBD), by designing, implementing, operating and iterating the behavioral health medical management approaches to whole person health.

  • Assuring that the GBD behavioral health medical management operations align both with the overall GBD whole person approach to health care, and also align with the Anthem overall medical management approach to behavioral health.

Requirements include but are not limited to:

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

  • May be responsible for developing and implementing programs to improve quality, cost, and outcomes.

  • May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.

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

  • May be responsible for an entire clinical program.

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, and patients’ office visits with providers and external physicians.

  • 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.

  • 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

  • M.D. or D.O. required.

  • Active, unrestricted license to practice medicine in the state of KY or ability to obtain KY licensure required.

  • KY resident strongly preferred.

  • Current Board Certification by the American Board of Psychiatry and Neurology required.

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

  • Ability to travel locally may be required.

  • Experience working with: Medicaid, vulnerable populations, community services, and/or KY systems of care preferred.

  • Managed care experience a plus.

  • 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.

    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: PS41860-US

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