Anthem

Anthem.

  • San Diego, CA


  • Long-term.

  • Full-time.

Description SHIFT: Day Job

SCHEDULE: Full-time

Clinical Operations Associate Medical Director

Location: This position has actually been authorized to work remote; nevertheless, the imcumbent needs to reside in the state of California.

Be part of a remarkable group

We are searching for leaders at all levels of the company who are enthusiastic about making an effect on our members and the neighborhoods we serve. You will prosper in a complex and collective environment where you do something about it and ownership to fix issues and lead modification. Do you wish to become part of a bigger function and a developing, high-performance culture that empowers you to make an effect?

Build the Possibilities. Make a remarkable effect.

AIM Specialty Health is a benefit-management leader in Illinois and a happy member of Anthem’s household of business. Our platform provides substantial cost-of-care cost savings throughout a broadening set of medical domains, consisting of radiology, cardiology and oncology. Goal is presently looking for a Board-Certified Pain Management Physician to take part in pre-authorization and quality enhancement services for interventional discomfort management treatments including the spinal column and state-of-the-art diagnostic musculoskeletal imaging. Medical Directors in Clinical Operations identify the medical need of demands utilizing medical suitability standards and health insurance medical policy.

How you will make effect:

  • Determine medical requirement of demands utilizing appropriate medical requirements, which might consist of AIM Appropriateness Guidelines, client-specific health insurance medical policy, reputable evidenced-based standards, and CMS Coverage Determinations, as relevant.
  • Perform physician-level case evaluation of interventional discomfort management usage demands including the spinal column such as epidural injections (interlaminar/caudal and transforaminal), epidural adhesiolysis, aspect joint injection, radioablation, local supportive nerve block, sacroiliac joint injections, spine stimulators, and thermal intradiscal treatments following preliminary medical evaluation by a therapist customer or a nurse customer.
  • Perform physician-level case evaluation of modern diagnostic musculoskeletal imaging demands following preliminary medical evaluation by a therapist customer or a nurse customer.
  • Conduct peer-to-peer assessments with purchasing doctors, doctor assistants, and advanced practice nurses concerning developed standards and accepted requirements of care as it associates with interventional discomfort management treatments, imaging, and proper websites of service.
  • Discuss scientifically suitable option treatments, imaging research studies, and websites of care with purchasing service providers when constant with suitable medical requirements.
  • Provide education relating to appropriate medical requirements.
  • Perform first-level service provider appeals of protection choices.
  • Demonstrate and preserve understanding of suitable medical requirements and pertinent AIM policies referring to usage evaluation.
  • Demonstrate and keep understanding of relevant ICD-10, HCPCS, and CPT coding standards as it associates with interventional discomfort management services and treatments.
  • Provide assistance and inform internal scientific and non-clinical personnel to cultivate understanding of the concepts connected with proper musculoskeletal medical diagnoses, treatments and management.
  • Actively take part in doctor group conferences.
  • Actively take part in groups that establish, modify and boost medical suitability standards.
  • Obtain extra state licensure based upon state guidelines and health insurance requires.
  • Adhere to all AIM Specialty Health procedures, policies, and treatments.

Qualifications

  • Requires an MD and Board accreditation in a medical specialized needed

Preferred Qualifications:

  • Board Certification in Pain Management by the American Board of Anesthesiology, The American Board of Psychiatry and The American Board of Neurology, or the American Board of Physical Medicine and Rehabilitation
  • 3-5 years of medical practice experience post-fellowship training is chosen.
  • Demonstrated understanding of present practice requirements in interventional discomfort management.
  • Strong oral interaction and social abilities.
  • Computer literacy with the capability to find out brand-new applications.
  • Strong analytical abilities.
  • Ability to multi-task.
  • Ability to work both separately and in a group environment.
  • Ability to operate in a vibrant, busy environment

We provide a variety of market-competitive overall benefits that consist of benefit boosts, paid vacations, Paid Time Off, and reward benefit programs (unless covered by a cumulative bargaining arrangement), medical, oral, vision, brief and long term impairment advantages, 401( k) match, stock purchase strategy, life insurance coverage, health cares and monetary education resources, among others.

The health of our partners and neighborhoods is a leading concern for Anthem. We need all brand-new prospects to end up being immunized versus COVID-19 If you are not immunized, your deal will be rescinded unless you supply – and Anthem authorizes – a legitimate spiritual or medical description regarding why you are unable to get immunized that Anthem has the ability to fairly accommodate. Anthem will likewise follow all pertinent federal, state and regional laws.

Anthem, Inc. has actually been called as a Fortune 100 Best Companies to Work For ®, is ranked as one of the 2020 World’s Most Admired Companies amongst health insurance companies by Fortune publication, and a 2020 America’s Best Employers for Diversity by Forbes. To read more about our business and use, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity company and all certified candidates will get factor to consider for work without regard to race, color, faith, sex, age, nationwide origin, secured experienced status, impairment status, sexual preference, gender identity or expression, marital status, hereditary details, or any other particular secured by law. Candidates who need lodging to take part in the task application procedure might call for help.

Please be encouraged that Anthem just accepts resumes from companies that have actually a signed contract with Anthem. Appropriately, Anthem is not bound to pay recommendation costs to any company that is not a celebration to a contract with Anthem. Hence, any unsolicited resumes, consisting of those sent to working with supervisors, are considered to be the residential or commercial property of Anthem.

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