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 benefits companies and a Fortune Top 50 Company. This position will be supporting our local Medicaid Business in the state of NV.
The position is office-based in Las Vegas, NV with an opportunity for some W@H after the completion of the training upon the hiring manager's discretion. Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received. Primary duties may include, but are not limited to: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
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. Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.
Supports the medical management staff ensuring timely and consistent responses to members and providers. Requires M.D. or D.O.; Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed; Internal Medicine or Family Medicine Board Certification preferred.
Must possess an active unrestricted medical license to practice medicine or a health profession in the state of Nevada. 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. 5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
2-3 years of managed care admin experience highly preferred. Ability to work weekends/holidays on a rotating basis may be required. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Proficiency with MS products (Word, Excel) and familiarity with large electronic system (for example EMRs) required. An Equal Opportunity Employer/Disability/Veteran Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity.
To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.