Director Clinical Analytics - Medical Doctor (Remote)

Description

Title: Director Clinical Analytics - MD

Location: US Remote near any Anthem office preferred

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

How you will make an impact:

Responsible for directing and leading all aspects of clinical affairs and analytics.

• Monitors the development of clinical practice guidelines by major medical specialty organizations.
• Oversees, develops, implements, and maintains the technical specifications for computer algorithms. Identifies opportunities to improve quality and safety of care and/or reduce cost of care.
• Monetizes prioritized rules aligned with cost of care and quality initiatives.
• Oversees economic analyses to identify cost savings of health interventions.
• Oversees the design, implementation, and analysis of studies to determine the clinical and financial effectiveness of products and services.
• Oversees the methodologies to identify potential fraud and abuse.
• Provides clinical input, trending of clinical service use and implication, and documentation to support clinical areas on internal committees.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports (12 associates).Pre

Qualifications

Minimum Requirements:

• Requires MD
• Minimum of 5 years clinical experience 
• Minimum of 5 years management experience
• Minimum of 2 years of experience in health services research, quality improvement, population health, disease management or utilization management; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Familiarity with standard medical coding and respresentation schemes (ICD-9, HCPCS, CPT-4, hospital revenue codes, LOINC, and NDC) and experience analyzing health care claims data strongly preferred.
• Previous experience with clinical data standards.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. 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.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.