Director Medical Operations Physician role

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 as needed. Serves on company committees and may be required to represent Anthem 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 and supports the medical management staff ensuring timely and consistent responses to members and providers. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

M.D. or D.O.
Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA)
An active unrestricted medical license to practice medicine
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
10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Preferences:

Three years Utilization Management and managed care experience
Leadership background