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Anthem, Inc. Chief Medical Officer, AIM Specialty Health in Chicago, Illinois

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At AIM Specialty Health (AIM) , a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and 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. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

About AIM Specialty Health:

AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe, and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation’s leading health benefits companies.

AIM provides innovative clinical solutions that focus on today’s most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.

With evidence-based medicine, technology, people, and processes, we support clinical appropriateness review, provider collaboration, and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.

Today our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online Provider Portal and experienced contact center-based teams that are enabled by our business platform.

Our pioneering spirit and dedication to improving health care continue to produce significant industry-first advancements, quality recognition achievements, and high user satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received full accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)

Position Description:

The Chief Medical Officer (CMO) is a member of the AIM executive team reporting directly to the CEO and is responsible for the overall clinical performance and integrity of all AIM solutions ensuring that all programs improve the appropriateness of care, patient outcomes, and reduce cost. He/she is the lead clinical spokesperson for the company interacting with internal and external clients and stakeholders including national and state professional associations and societies; state and national governmental and regulatory agencies; and accreditation organizations. This individual is expected to develop strong relationships with client CMOs and other executives and be a strong partner to the Solutions, Sales, Client Partnerships, and Operations organizations within AIM.

The CMO leads a team of domain expert clinicians who are responsible for the clinical development of their respective solutions, including the overall strategic approach, program design, and clinical underpinnings (clinical evidenced-based guidelines that are the foundation for the interventions which will be made by AIM on behalf of its clients.) These clinicians contribute to program innovation and evolution over time to increase efficiency and impact.

The CMO is also responsible for leadership of the Clinical Program and Solution Authoring Organization which performs the evidence discovery and curation, critical components of guideline development and maintenance as well as translation of the guidelines into system useable algorithms that support AIM’s automated, portal-based prior authorization capability. In partnership with the Solution Medical Directors, The Solution GMs and Operations the Clinical Programs and Solution Authoring Organization work to continuously improve the performance of AIM’s solutions supporting delivery of higher value from a quality and cost perspective.

Finally, the CMO oversees AIMs Anthem relationship supporting the Anthem client management organization, the Anthem implementation team as well as overseeing AIMs Cost of Care (CoC) program which focuses on developing programs and initiatives that will support Anthem’s annual CoC targets.

Responsibilities:

Primary duties may include but are not limited to:

  • Ensuring the clinical integrity of AIMs clinical solutions from development through delivery

  • Supporting sales and client management

  • Represent AIM in partnership with the CEO and SVP of Client Partnerships externally to client executive teams, and national and state-based organizations

  • Lead the relationship with Anthem clinical and non-clinical leaders

  • Delivery of AIMs annual cost of care targets working closely with the Anthem CoC team and the teams at AIM responsible for execution and delivery

  • Recruitment, retention and career development across his/her areas of responsibility

  • Monitor competitors’ products, emerging companies and technologies as sources of ideas for innovation and improvement

  • Collaborate with others to continually drive innovation and improvement that support greater value and ease of implementation and use

  • Identify potential partnership and acquisition opportunities and participate in the evaluation of these opportunities

  • Support clinical collaboration across DBG to enhance its program and service offerings

Qualifications

  • Licensed and Board Certified Medical Doctor

  • Advanced business training highly desirable (MPH, MBA, or similar)

  • A minimum of 5 years of clinical experience. 10 years of progressive health care leadership/management experience across multiple segments of the industry

  • Thorough understanding of all aspects of the US health care system including but not limited to health care economics, health care delivery, utilization management, case management, utilization review, health insurance, government programs etc.

  • Experience with clinical coding (ICD-10, CPT, etc.), medical informatics, and EMRs all helpful but not required

  • Demonstrated ability to work collaboratively with other clinicians and non-clinicians

  • Demonstrated experience and effectiveness in motivating and mentoring others who are in a direct reporting relationship

  • Ability to communicate effectively in writing, orally, and with others to assimilate, understand and convey information in a manner consistent with job functions. Prepare clear and concise reports, correspondence, thought leadership pieces and other written materials

  • Demonstrated ability to deliver effective presentations to all size groups

Anthem, Inc. is ranked as one of America’s 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.

REQNUMBER: PS45164

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