Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality of care management processes and activities. Primary duties may include, but are not limited to: Provides support to clinicians in daily tasks and ensuring timely and consistent responses to members and providers, conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary. May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees, and 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. Requires: M.D. or D.O. Requires current ABMS board certification Requires current, unrestricted medical license Requires 10 years of clinical experience or or any combination of education and experience, which would provide an equivalent background Requires ability to work occasional holiday and off shift Managed care experience preferred Qualified candidates will be based in one of these Anthem offices: Wallingford CT, Mason OH, St Louis, Virginia Beach, Morristown NJ, Louisville, Las Vegas, Minneapolis, Chicago, Atlanta, Savannah or Grand Prairie TX PS18276Salary Range: NAMinimum Qualification8 - 10 years Associated topics: bilingual, clinic, family, family practice, physician md, physician md do, practice physician, primary care, provider, urgent care
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