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Provider Performance Medical Director - Oklahoma (Remote) - PS38770

Company: Anthem, Inc.
Location: Oklahoma City
Posted on: September 15, 2020

Job Description:

Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well stay connected with Anthem. Here are a few of the updates you may notice:

No more profiles! We no longer require you to create a log in and password to apply for a job and you won't be able to access previously created profiles, but don’t worry – we still have your previous application(s) on file. Due to technical difficulties currently being resolved, the ‘Track Your Job Application Status’ functionality is not available.

Job Alerts – If you had previously registered to receive job alerts and wish to continue to receive these notifications, please re-register by clicking the “job alert” button.

NEW! Didn’t find a job that is right for you? Join a Talent Network to stay informed on news and job opportunities with the Anthem Team!

It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply

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 overall costs.

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 determinations.

Engages with providers in joint operating committees and builds relationships with clinical leadership of provider collaboration groups.

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 program.

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 directors.

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

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 performance.

Drives strategies around cost of care and analytic tools and reporting.

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 company.

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 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

This position will be located in the state of OK. Candidate must reside in OK or be willing to relocate (relocation assistance may be available).

M.D. or D.O.

Board certification approved by the American Board of Medical Specialties required.

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 preferred.

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 Employer/Disability/Veteran.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.

EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.

*WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the ‘Rip-offs and Imposter Scams’ option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., Oklahoma City , Provider Performance Medical Director - Oklahoma (Remote) - PS38770, Other , Oklahoma City, Oklahoma

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