Associate Medical Director, Clinical Operations - Physical Medicine/Rehabilitation (AIM) Chicag[...]

Compensation

: $92,940.00 - $149,980.00 /year *

Employment Type

: Full-Time

Industry

: Healthcare - Allied Health



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Associate Medical Director, Clinical Operations - Physical Medicine/Rehabilitation (AIM) Chicago Area PS25825

Associate Medical Director, Clinical Operations - Physical Medicine and Rehabilitation

Location: Candidates must reside in the Chicago area; may work remote at Manager's discretion.

Your Talent. Our Vision. AtAIM Specialty Health(AIM), a proud member of the Anthem, Inc. family of companies, its a powerful combination, and the foundation upon which were creating greater 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.

AIM is currently seeking a Board-Certified Physical Medicine and Rehabilitative Medicine Physician to participate in pre-authorization and quality improvement solutions for rehabilitative therapeutic services involving physical therapy, occupational therapy, speech therapy and high-tech diagnostic musculoskeletal imaging.Medical Directors in Clinical Operations determine the medical necessity of requests using clinical appropriateness guidelines and health plan medical policy.

Successful candidates will:

  • Determine medical necessity of requests using applicable clinical criteria, which may include AIM Appropriateness Guidelines, client-specific health plan medical policy, well established evidenced based guidelines and CMS Coverage Determinations, as applicable.
  • Perform physician-level case review of rehabilitative therapeutic services and high-tech diagnostic musculoskeletal imaging requests following initial clinical review by a therapist reviewer or a nurse reviewer.
  • Conduct peer-to-peer consultations with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to rehabilitative therapeutic services and appropriate sites of service.
    • Discuss clinically appropriate alternative treatments and sites of care with ordering providers when consistent with applicable clinical criteria.
    • Provide education regarding applicable clinical criteria.
  • Perform first level provider appeals of coverage decisions.
  • Demonstrate and maintain knowledge of applicable clinical criteria and relevant AIM policies pertaining to utilization review.
  • Provide support and educate internal clinical and non-clinical staff to foster understanding of the principles associated with appropriate musculoskeletal diagnoses, treatments and management.
  • Actively participate in physician team meetings.
  • Actively participate in groups that develop, revise and enhance clinical appropriateness guidelines.
  • Obtain additional state licensure based upon state regulations and health plan needs.
  • Adhere to all AIM Specialty Health protocols, policies, and procedures.

Qualified Candidates will have:

  • Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in an appropriate state.
  • Board Certification by the American Board of Physical Medicine and Rehabilitation.
  • 3-5 years of post residency clinical experience is preferred
  • Demonstrated knowledge of current practice standards in physical medicine and rehabilitation.
  • Strong oral communication and interpersonal skills.
  • Computer literacy with the ability to learn new applications.
  • Strong analytical skills.
  • Ability to multi-task.
  • Ability to work both independently and in a team environment.
  • Ability to work in a dynamic, fast-paced environment.

Anthem, Inc. is ranked as one of AmericasMost Admired Companies among health insurers by Fortune magazine and is a 2018DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at antheminc.com/careers.

An Equal OpportunityEmployer/Disability/Veteran

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Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ...@icareerhelp.com for further assistance.

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*WARNING : Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application.


Associated topics: antibody, disease, drug discovery, immunoassay, medicine, microbiology, physiologist, therapy, transfection, trauma * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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