Anthem In. Case Management Jobs

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Anthem, Inc. Medical Director in Hacienda Heights, California


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Medical Director/ California

This is a full time salaried position that is located in California. Telecommuting may be considered. The team works across time zones so flexibility in hours worked is needed. Limited travel.

Responsible for providing day-to-day guidance, support, and leadership for the clinical and quality activities of utilization and case management for the National Account operational team. The Medical Director ensures the clinical integrity of broad and significant clinical programs, and identifies and develops opportunities for innovation to increase effectiveness and quality. Primary duties may include, but are not limited to:

· Day to day clinical responsibilities means that the medical director provides clinical oversight for Utilization Management, Case Management, and Disease Management of the Clinical Team. Primary duties may include, but are not limited to: case reviews for both utilization and case management issues, consistent adoption and implementation of all medical policies, leading multidisciplinary rounds, and peer to peer outreach for both UM and CM issues, identifying quality issues, clinical report reviews, trend management, benefit design consultation, and supporting overall clinical performance guarantee success.

  • The medical director may be required to provide clinical expertise in sales planning and participates in the acquisition and retention of client. Provides input on the clinical relevance of account reporting regarding use of medical services by members. Also will be involved in identifying and managing medical utilization trends and for proactively identifying and formulating solutions with Account Management/sales RVP Medical Directors.

  • Serves as a resource and consultant to other areas of the company and may be required to represent the business unit to internal or external entities. This may involve account facing activities so presentation and speaking ability is a plus.

  • Needs to function well on a team of physicians and other health professionals.


Requires M.D. or D.O.

  • Current Board certification approved by the American Board of Medical Specialties required (ABMS). Internal Medicine, Family Medicine, General Surgery, Emergency Medicine preferred. Other specialties will be considered.

  • Must possess an active unrestricted medical license to practice medicine in CA.

  • CA residence (Pacific time zone) required.

  • At least 5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.

  • 2 years of experience with utilization review preferred. Prior use of medical management systems is valued.

  • Knowledge and experience with population or segment health management is a plus.

  • Knowledge of health insurance industry and the National Accounts segment is also a plus. Must be a team player, collaborative and capable of independent work.

  • 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 2019 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE.

REQNUMBER: PS38534-California