Candidate must reside in the Los Angeles or Chicago area. Onsite office training required in one of the following offices: Glendale, CA; Westchester, IL; or Deerfield, IL. May work remote after training period.
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 Neurologic Surgeon to participate in pre-authorization and quality improvement solutions for musculoskeletal procedures involving the spine, and high-tech diagnostic imaging. Physician Advisors determine the medical necessity of requests using clinical appropriateness guidelines and health plan medical policy.
Primary duties may include, but are not limited to:
- Determines the medical necessity of requests using clinical criteria.
- Performs physician-level case review of musculoskeletal utilization requests.
- Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service.
- Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments.
- Performs first level provider appeals of coverage decisions.
- Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management.
- Participates in physician team meetings.
- Participates in groups that develop, revise and enhance clinical appropriateness guidelines.
Qualified Candidates will have:
- Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).
- M.D. or D.O. Board certification by the American Board of Neurologic Surgery, American Osteopathic Board of Neurosurgery, the American Board of Orthopedic Surgery, or American Osteopathic Board of Orthopedic Surgery.
- Experience performing standard neurosurgical spine procedures independently.
- 3-5 years of clinical practice experience past fellowship training preferred.
- Extensive spine surgery experience preferred.
- Demonstrated knowledge of current practice standards in neurosurgery.
- 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.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.
An Equal Opportunity Employer/Disability/Veteran