has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Īnthem, Inc. + Ability to work both independently and in a team environment + Computer literacy with the ability to learn new applications + Strong oral communication and interpersonal skills + Demonstrated knowledge of current practice standards in specialty + Requires a Board certification in a medical specialty + Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine + Adhere to all AIM Specialty Health Management protocols, policies, and procedures. + Obtain additional state licensure based upon business needs. + Perform first level provider appeals as designated by the client for adverse determinations. + Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert. + Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and sleep management. + Participate in periodic physician team meetings. + As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered modalities. + Demonstrate and maintain current knowledge of modalities and new applications of known technologies for diagnostic imaging, cardiac services and sleep management. + Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application. + Suggest alternatives services to ordering providers when appropriate. + Conduct peer-topeer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of care as they pertain to the use of diagnostic imaging studies, cardiac testing and sleep management services. + Determine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy. Imaging modalities include CT, CTA, MRI, MRA, PET, and Nuclear Cardiology. + Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology and sleep management requests using clinical guidelines and health plan medical policy. We are currently seeking a versatile Board Certified Physicians to participate in pre-authorization reviews of high-tech diagnostic imaging, cardiac testing and sleep management services. This is an exceptional opportunity to do innovative work that means more to you and those we serve. Join us and together we will drive the future of health care. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. At AIM Specialty Health ( AIM), a proud member of the Anthem, Inc. Associate Medical Director - AIM Specialty HealthĪt Anthem, Inc in Tucson, Arizona, United States
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