In this role, you will be responsible for chairing appropriate health services committees and providing leadership for pharmacy and health services utilization management projects for single-market health plans.
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 perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles.
In this role, the selected candidate will ensure the integrity of the clinical quality programs, including alignment with Anthem Medical Policies and Utilization Management Clinical Guidelines if applicable, observance of corporate governance and polices, and reporting into appropriate committees (e.g. Enterprise Clinical Quality Committee). May also serve on other quality committees, within Anthem, local states, or nationally to advance discussions to transform cancer care, quality measures, and alternative payment systems.