Anthem Medical Director Orthopedic Surgery - AIM Chicago - 139093 in Apple Valley, California
Medical Director Orthopedic Surgery - AIM Chicago - 139093
Location: United States
Requisition #: 139093
Post Date: May 11, 2018
This position will be located at AIM's corporate office located in Chicago IL, near O'Hare Airport.
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.
The Medical Director is responsible for ensuring the clinic integrity of the Musculoskeletal AIM solution, making sure the program improves the appropriateness of care, improves patient outcomes and reduces cost. The Medical Director to fill this role needs to be a Board Certified Orthopedic Surgeon. The Medical Director leads the clinical development of the solution, 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.) The Medical Director contributes to program innovation and evolution over time to increase efficiency and impact.
The Medical Director participates in sales meetings with prospective clients (including preparation, value estimate assessment and, input on the characteristics of the local medical market) as the program/solutions clinical expert. This will also include meetings with prospects’ clinical leadership to ensure they understand the clinical basis for the solution. The Medical Director supports the completion of RFIs and RFPs and other sales activities as needed to support the growth in (membership and revenue) of the solution.
The Medical Director supports client implementations and is a key member of the team supporting the client and in particular the client’s clinical leadership after implementation. This includes developing provider acceptance and support, answering clinical questions regarding the program, participating in conversations with the client’s key provider partners, as well as state specialty societies and other medical organizations and institutions.
The Medical Director acts as the key clinical leader supporting the call center clinical teams with respect to his or her solution. He or she is also involved in evaluating the solutions performance regarding impact and helping to analyze expected versus actual and the causes for any discrepancies. This includes synthesizing feedback from providers received directly, through the call center and through our clients to identify opportunities for improvement from an ease of use perspective and from and impact perspective.
Primary duties may include but are not limited to:
Provide the clinical expertise necessary to support a clinical, evidenced based program to improve appropriateness of care and reduce cost in the musculoskeletal domain.
Work collaboratively with the Clinical Content and Authoring Team, the Solutions Team and Operations, as the program evolves to improve performance and impact.
Support sales team and client executives with sales and client management activities as needed and be a clinical resource for them as well as our clients
Participate as a member of the CSSDS team supporting the other members in their efforts and activities as possible
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.
Stay abreast of clinical developments and advances in the specific domain and ensure that as appropriate they are incorporated into AIM’s solution.
Ability to represent the public face of the solution by interacting with professional societies, patient advocacy groups, government agencies, and the press and lay public as needed in collaboration with AIM marketing and communications.
Ability to represent the public face of the solution by interacting with professional societies, patient advocacy groups, government agencies, and the press and lay public as needed in collaboration with AIM marketing and communications
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 improve 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.)
The qualified candidate will have:
Medical Doctor currently licensed and board certified in Orthopedic Surgery.
A minimum of 12 years of healthcare experience, with at least 5 years of relevant clinical experience. Utilization management, case management, utilization review, or health care management experience helpful but not required
Experience in clinical coding (ICD-10, CPT, etc.), experience in medical informatics, and EMR experience all helpful but not required.
Requires experience with population or segment health management and the education and coaching of members on wellness, prevention, and healthy lifestyles.
Knowledge of leading competitive product offerings in the healthcare industry and marketplace standards and knowledge of National Accounts expectations 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 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.