Los Angeles, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 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: This position has been approved to work remote, anywhere in the US with preference given to candidates located in California.

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.


 

Qualifications

Qualified Candidates will have:

  • 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.
  • 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. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

 

Los Angeles, California

As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our Nation’s active, reserve, and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

Who We Are Looking For 

Anthem, Inc. is seeking military veterans across the country who bring a deeply rooted skillset that includes team-oriented approaches to problem-solving, demonstrations of leadership and an overall commitment to the mission of the organization.  If you are a military veteran or military veteran spouse, Anthem, Inc. is looking to hire you.

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military

Should I Apply?

Are you a transitioning member of the military or a military veteran who is looking for a civilian career that provides opportunities for growth and career advancement?  Anthem, Inc. is currently looking for job seekers with  Operations experience.  If you are interested in a career in one of these fields, check out our current open positions to the right for more information and to apply today!

What Happens After I Apply?

Once you click ‘Apply Now’ on an Anthem, Inc. job posting, you will be re-directed to fill out an application on Anthem's career page.  In order to be considered for next steps, please complete the application on Anthem's career page and make sure you have an updated resume uploaded to your RecruitMilitary profile.  Once Anthem, Inc. reviews your resume and profile, a recruiter will reach out to provide you with more information and to schedule you for an interview.

How to Win An Interview

1.     Review the job description for the specific position you are applying for.

2.     Review the company website. Know their mission and values. What do they do? What are their products?

3.     Prepare a few questions to ask on your interview.

4.     Prepare to discuss your military or civilian background and how it relates to the position. 

5.     Check out our Resources tab for resume guidance, interview prep and more!

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