Anthem, Inc. Associate Medical Director - PM&R in San Jose, California
SHIFT: Day Job
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 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 preauthorization and quality improvement solutions for therapeutic services involving physical therapy, occupational therapy, speech therapy. AIM collaborates with health care providers to promote appropriate and effective use of therapy visits to ensure quality patient outcomes.
Location: This position has been approved to work remotely from anywhere in the US.
Primary duties may include, but are not limited to:
Determine medical necessity of requests using applicable clinical criteria.
Perform physician-level case review of requests for therapeutic services.
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
Provide support and educate internal clinical and non-clinical staff to foster understanding of the principles associated with appropriate therapeutic services and management.
Participate in physician team meetings.
Participate in groups that develop, revise and enhance clinical appropriateness guidelines.
Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine.
Board Certification by the American Board of Specialties
Preferred criteria in addition to requirements:
Physical Medicine and Rehabilitation Board Certification
3-5 years of clinical practice experience past fellowship training 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
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. Anthem, Inc. 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. 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.