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Neurologic Surgery Senior Phys...

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Job Summary

Company
Anthem
Location
Deerfield, IL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS3618

Neurologic Surgery Senior Physician Advisor MSK - AIM - PS3618

About the Job

Description
This position may be located in Westchester or Deerfield, IL; or in Glendale, CA
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.

About AIM Specialty Health
AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation's leading health benefits companies.

AIM provides innovative clinical solutions that focus on today's most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.

With evidence-based medicine, technology, people and processes, we support clinical appropriateness review, provider collaboration and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.

Today, our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses, and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online ProviderPortal and experienced contact center-based teams that is enabled by our business platform.

Our pioneering spirit and dedication to improve health care continues to produce significant industry-first advancements, quality recognition achievements, and high satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)

We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL, as well as Glendale, CA.

To learn more, visit www.aimspecialtyhealth.com
Qualifications
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.
  • Preferred experience with utilization management, especially with CMS guidelines.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

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