The Medical Director is responsible for providing clinical expertise, oversight for medical policy implementation and business direction in support of the development, implementation, and evaluation of clinical/medical programs to promote the delivery of high quality, constituent responsive medical care.
In this role, you will be responsible for supporting cross-functional and global collaborations to integrate broad medical, scientific, and commercial input into the development program including scientific presentation at advisory boards, key scientific meetings and external committee meetings.
In this role, the selected candidate will conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls.
In this role, the candidate will direct and develop the veterinary, technical and administrative staff towards the goal of quality patient care and excellent client service; assist in the formulation of objectives and policies to ensure efficient and profitable hospital operations.
In this role, you will serve as a resource and knowledge expert for the region on HCC activities, coding, documentation and accountable for the overall improvement and performance of HCC in the assigned region.
The Business Info Analyst ll is responsible for analyzing, reporting and developing recommendations on data related to multiple, varied business metrics for Anthem Kentucky Medicaid Clinical Quality Management business unit.
The Medical Director works actively to implement and administer medical policies, disease and medical care management programs, integrate physician services, quality assurance, appeals and grievances, and regulatory compliance programs with medical service and delivery systems to ensure the best possible quality health care for Health Net members.
The Senior Medical Director is a high-profile, client facing role, requiring collaboration and strong client relationships across all levels of the organization to ensure goals are met. This executive physician will be comfortable interacting daily on the floor with clinicians including case management, nurses, social workers, administrative, and physician staff.
In this role, you will prepare safety information to support licensing partners, review safety documents prepared by licensing partners, and communicate with licensing partners on safety matters per the safety agreement.