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Associate Medical Director – AIM

Anthem, Inc

This is a Full-time position in Anaheim, CA posted April 6, 2021.

nnDescription nn nnSHIFT: Day Jobnn nnSCHEDULE: Full-timenn nnYour Talent.

Our Vision.

At AIM Specialty Health (AIM), a proud member of the Anthem, Inc.

family of companies, its a powerful combination, and the foundation upon which were creating greater 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.nn nnWe are currently seeking a versatile Board Certified Physicians to participate in pre-authorization reviews of high-tech diagnostic imaging, cardiac testing and sleep management services.

Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology and sleep management requests using clinical guidelines and health plan medical policy.nn nnSuccessful candidates will:nn nnPerform physician-level case review, following initial nurse review, of high-tech diagnostic imaging.

Imaging modalities include CT, CTA, MRI, MRA, PET, and Nuclear Cardiology.nn nnDetermine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy.nn nnConduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of care as they pertain to the use of diagnostic imaging studies, cardiac testing and sleep management services.nn nnSuggest alternatives services to ordering providers when appropriate.nn nnDocument the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.nn nnDemonstrate and maintain current knowledge of modalities and new applications of known technologies for diagnostic imaging, cardiac services and sleep management.nn nnAs necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered modalities.

nn nnParticipate in periodic physician team meetings.nn nnDemonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and sleep management.nn nnParticipate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.nn nnPerform first level provider appeals as designated by the client for adverse determinations.nn nnObtain additional state licensure based upon business needs.nn nnAdhere to all AIM Specialty Health Management protocols, policies, and procedures.nn nnQualifications nn nnQualified Candidates will have:nn nnCurrent unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicinenn nnBoard Certification by American Board of Medical Specialtiesnn nnInternal Medicine, Family Medicine and Emergency Medicine preferrednn nnDemonstrated knowledge of current practice standards in specialty nn nnStrong oral communication and interpersonal skillsnn nnComputer literacy with the ability to learn new applicationsnn nnStrong analytical skillsnn nnAbility to multi-tasknn nnAbility to work both independently and in a team environmentnn nnAbility to work in a dynamic, fast-paced environmentnn nnWe offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc.

is ranked as one of Americas 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.

Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.nn nnREQNUMBER: PS46739nn

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