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.
We are currently seeking several versatile Board Certified Medical and Radiation Oncologists to participate in pre-authorization reviews related to oncology care. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cancer chemotherapy and genetic testing requests using clinical guidelines and health plan medical policy.
Location: Remote, work from home
Successful candidates will:
- Perform physician-level case review, following initial nurse review, of radiation therapy regimens and supportive care.
- Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging. Imaging modalities include CT, CTA, MRI, MRA, and PET.
- Determine medical necessity of requests using AIM Medical Necessity Guidelines and client-specific health plan medical policy.
- Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
- Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application.
- Demonstrate and maintain current knowledge of new cancer treatment regimens.
- As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing. Participate in periodic physician team meetings.
- Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care.
- Participate on committees or in work groups as needed for revision of clinical guidelines and/or serve as a subject matter expert.
- Perform first level provider appeals as designated by the client for adverse determinations.
- Obtain additional state licensure based upon business needs.
- Adhere to all AIM Specialty Health Management protocols, policies, and procedures.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
- Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine Board Certification by American Board of Medical Specialties in Medical Oncology or Radiation Oncology.
- 3-5 years of clinical practice experience past fellowship training is desirable.
- Demonstrated knowledge of current practice standards in oncology. Strong oral communication and interpersonal skills.
- Intermediate computer skills (including MS Office and Outlook), ability to learn new applications.
- Strong analytical skills.
- Ability to multi-task.
- Ability to work both independently and in a team 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.