Medical Director Associate or Medical Director 40462 - (US-OH-Mason - 45040)

Minimum Education: Tech School
Job Type: Full Time
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WellPoint
is the nation's leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.
Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.


Position may exist as either Medical Director Associate or Medical Director based on candidates skills and experience.

Responsible for the administration of medical services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies of the business unit. Primary duties may include, but are not limited to: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Participates in a physician on-call rotation for a 24x7 pre-certification unit. Assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. Requires Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company. May chair or serve on company committees. May be required to represent WellPoint to external entities and/or serve on external committees.

Skills:
MD required with Board Certification required, 5 years of experience with extensive managed care or Medicare knowledge. Requires board certification where applicable to the duties being performed. Must be able to pass through standard physician credentialing process. Advanced written, oral and interpersonal communication skills required. Advanced analytical and problem-solving skills required. Excellent computer skills, tactical planning, and organizational skills also required. Proven leadership and project management skills essential. This position may require some travel. WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2008 DiversityInc magazine Top 50 Company for Diversity.

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