April 8, 2021
Indianapolis, Indiana
Job Type
Work Setting


Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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 at one of America's leading health care companies and a Fortune Top 50 Company.

This position will have a primary focus on readmission reviews for our Medicare business.  Individuals in this position will actively participate in the dispute resolution process.

Responsible for the administration of physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.

Primary duties may include, but are not limited to:

  • Supports clinicians to ensure timely and consistent responses to members and providers.
  • Provides guidance for clinical operational aspects of a program.
  • Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.
  • May conduct peer-to-peer clinical case reviews with attending physicians or other ordering providers to discuss review determinations and outcomes.
  • Serves as a resource and consultant to other areas of the company.
  • May be required to represent the company to external entities and/or serve on internal and/or external committees.
  • May chair company committees.
  • Interprets medical policies and clinical guidelines.
  • May develop and propose new medical policies based on changes in healthcare.
  • Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
  • Identifies and develops opportunities for innovation to increase effectiveness and quality.



This position is remote and can be located in one of the following states: MO, KY, IN, OH, TN, WI, LA, IA.

  • M.D. or D.O required.
  • 5 years of clinical experience and additional experience in extensive managed care knowledge (or any combination of education and experience, which would provide an equivalent background) required.
  • Requires a current unrestricted medical licensure in any US applicable state(s).
  • Current and active Board Certification approved by the Americal Board of Medical Specialties (ABMS) required. Family Practice, Internal medicine, Emergency Medicine preferred. Other specialties will be considered.
  • Knowledge and experience with population or segment health management is a plus.
  • Medicare experience a plus.
  • Knowledge of health insurance industry and the National Accounts segment a plus.
  • Must be a team player, collaborative, and capable of independent work.

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 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.

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