Anthem Medical Director Associate (Behavioral Health) - Remote Part time (20 hours) 133744 in Shelbyville, Indiana

Medical Director Associate (Behavioral Health) - Remote Part time (20 hours) 133744


Location: Washington, United States

Field: Medical

Requisition #: 134744

Post Date: 1 day ago

Your Talent. Our Vision. At Amerigroup , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals,it’s a powerful combination. It’s the foundation upon which we’re 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 .

The Behavioral Health Medical Director will provide leadership in integrating physical and behavioral health and will be devoted to developing and maintaining relationships with providers, consumers and advocate organizations and health plan leadership which includes the plan President, COO, CFO, Medical Director and clinical staff. The person in this position will also be actively engaged with the state customer to develop a collaborative relationship and maintain that relationship as a partner in the medical management of Medicaid recipients.

In addition, the Medical Director will also be expected to participate in the utilization management process in working with providers and providing clinical consultations, determinations of medical necessity and alternative levels of care.

An exciting and challenging position in an ever changing healthcare environment with responsibility for behavioral health leadership in the administration of behavioral health services for the health plan. This includes leadership in determining the overall medical policies of the business unit to ensure that the appropriate and most cost effective medical care is received for the benefit of the member, leading the integration of behavioral and physical health services and developing the relationships with providers, consumer organizations, the state customer and other stakeholders .

Collaborate and cooperate with the Enterprise GBD BH Division to meet the Pillar and Investment Initiatives targets of improvements in capabilities at plan level to meet expectations of the investments made in the BH program. Represent or co-represent the plan on the MBHO/NCQA QM and UM Operations Committees. Lead development of COC initiatives to meet Enterprise expectations in improving effectiveness and efficiency.

Primary duties may include, but are not limited to:

  • Interprets existing policies and assists in developing new policies based on changes in the behavioral health or medical arena.

  • 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. also is a member of either a regional or corporate call group for this purpose.

  • Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

  • Identifies and leads development of opportunities for innovation to increase effectiveness and quality.

  • Actively promotes the integration of physical and behavioral health including substance abuse while maintaining awareness of the social needs of individuals which impacts their health status

  • Works closely with the Health Plan Chief Medical Officer and the Behavioral Health Program Leaders in program development, staff leadership, health care integration and any other activities as needed to improve outcomes, quality measures and appropriate utilization of resources.

  • Supports the medical management staff ensuring timely and consistent responses to members and providers

Other Duties as Required

  • 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,

  • The Behavioral Health Medical Director will maintain an active and responsive relationship with internal leadership of the health plan as well as the clinical staff and with corporate leadership in Behavioral Health. There will be a need to participate in strategic planning, including program design, strategy development and implementation as well as quality initiatives in relationship to providers and members.

  • Works with Provider Relations and other clinical leadership staff for the purpose of provider engagement.

  • Requires M.D. or D.O.

  • Current Board certification by the ABMS

  • Must possess an active unrestricted medical license to practice medicine in a US state.

  • At least 5 years of clinical experience

  • Washington residency preferred

  • Knowledge and understanding of Medicaid health plans preferred.

  • Must possess a comfort level with and knowledge about NCQA accreditation, specifically HEDIS measures and understands the need to constantly improve these values within the health plan to achieve established targets.

  • Understands and uses data analysis for quality improvement, care management and utilization management and in shaping provider behavior

  • 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 America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.