Provider Performance Medical Director - Oklahoma (Remote) -
PS38770 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.
This position will be supporting our Medicaid Business in the
state of Oklahoma.
Primary duties may include, but are not limited to:
Responsible for the administration of physical health medical
services, to ensure the appropriate and most cost effective medical
care is received.
Interprets medical policies and clinical guidelines.
Responsible for the provider performance program enterprise wide
by persuading physician groups, local markets and medical staff of
the value of the program for members improved quality of care,
lower cost of services and improved financial reimbursement for
providers who are successful in managing quality, access and
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.
Conducts peer-to-peer clinical appeal case reviews with
attending physicians or other ordering providers to discuss review
Engages with providers in joint operating committees and builds
relationships with clinical leadership of provider collaboration
Responsible for developing and implementing programs to improve
quality, cost, and outcomes.
Provides clinical consultation and serves as clinical/strategic
advisor to enhance clinical operations.
Accountable for achieving performance results in value based
care by engaging, influencing and supporting physicians.
Supports clinicians to ensure timely and consistent responses to
members and providers.
Provides guidance for clinical operational aspects of a
Designs and develops national level interventions leveraging
existing tools that will drive performance in value based care.
Provides expertise, captures and shares best practices across
regions to provider partners as well as Anthem medical
May serve as a resource to staff including Medical Director
Works with the Care Delivery Transformation team to develop and
deliver high impact field interventions, supporting content
development and practice transformation embedded capabilities
improving provider performance.
Influences and partners with local market medical and financial
leadership to ensure appropriate level of focus on performance of
providers in the program.
Collaborates with Provider Enablement leadership team to bring
insight, innovation and opportunities that help drive
Drives strategies around cost of care and analytic tools and
Develops understanding of value based contracts across lines of
business in a region.
Additional duties may include, but are not limited to:
Serves as a resource and consultant to other areas of the
May be required to represent the company to external entities
and/or serve on internal and/or external committees.
May chair company committees.
May develop and propose new medical policies based on changes in
Leads, develops, directs and implements clinical and
non-clinical activities that impact health care quality cost and
Identifies and develops opportunities for innovation to increase
effectiveness and quality.
This position will be located in the state of OK. Candidate must
reside in OK or be willing to relocate (relocation assistance may
M.D. or D.O.
Board certification approved by the American Board of Medical
Board certified in Internal Medicine, Family Medicine, Emergency
Medicine, Pediatrics, OBGYN strongly preferred.
Active unrestricted medical license to practice medicine in
state of OK or ability to acquire OK licensure required.
10 years of clinical experience; or any combination of education
and experience, which would provide an equivalent background.
1-3 years of experience with utilization review/ managed care
background a plus.
5+ years of managerial/leadership experience highly
30% travel in the state of OK may be required.
MBA, MHA or MPH degree preferred.
Strong communication, interperonal skills, and
presentation skills required.
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