• Anthem
  • $101,840.00 -80,040.00/year*
  • Watertown , MA
  • Healthcare - Allied Health
  • Full-Time
  • 2 Barnard Ave

Behavioral Health Medical Director - KY Preferred or Remote (PS20512 )
**Location:** **Louisville, Kentucky, United States**
**Requisition #:** PS20512
**Post Date:** 6 hours ago
_Your Talent. Our Vision._ **At Anthem, Inc.,** its a powerful combination, and the foundation upon which were 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.
**Behavioral Health Medical Director - Remote**
There are two main focuses of the position.
+ Improving the health of the people we serve in the Government Business Division (GBD), by designing, implementing, operating and iterating the behavioral health medical management approaches to whole person health.
+ Assuring that the GBD behavioral health medical management operations align both with the overall GBD whole person approach to health care, and also align with the Anthem overall medical management approach to behavioral health.
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 and for the day-to-day management of medical management staff. 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.
M.D. or D.O.
Board certification approved by the American Board of Psychiatry and Neurology required
Must possess an active unrestricted medical license to practice medicine
10 years of clinical experience or any combination of education and experience, which would provide an equivalent background
Additional board certification in either child psychiatry or addiction medicine preferred
UM review experience preferred
Knowledge of and experience with Medicaid and Medicare UM preferred
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
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
**_Anthem, Inc. is ranked as one of Americas 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._**
Associated topics: cmo, demand, demand generation, donor, fundraise, government, major gift, regulatory, solicitation, stewardship

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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