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Oncology/Hematology Senior Phy...

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Job Summary

Company
Anthem
Location
Glendale, CA
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_135905

Oncology/Hematology Senior Physician Advisor - AIM - 135905

About the Job

Description
This position may located in Glendale, CA; or Deerfield or Westchester, Illinois
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 Oncologist and/or Hematologist to participate in pre-authorization and quality improvement solutions for our oncology and diagnostic imaging solutions. Physician Advisors determine the medical necessity of outpatient requests using clinical appropriateness guidelines and health plan medical policy.
Successful candidates will:
  • Perform physician-level case review, following initial nurse review, of oncology and high-tech diagnostic imaging requests.
  • Determine medical necessity of requests using AIM Clinical Appropriateness Guidelines and client-specific health plan medical policy
  • Conduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.
  • Suggest alternative treatments, studies and sites of care to ordering providers when appropriate
  • Provide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered oncology and diagnostic imaging modalities.
  • Actively participate in physician team meetings.
  • Demonstrate and maintain knowledge of relevant policies and regulations pertaining to medical oncology and imaging modalities.
  • Actively participate in groups that develop, revise and enhance clinical appropriateness guidelines
  • Perform first level provider appeals of coverage decisions.
  • Obtain additional state licensure based upon state regulations and health plan needs
  • Adhere to all AIM Specialty Health protocols, policies, and procedures
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) to practice medicine as a Doctor of Medicine or Doctor of Osteopathic Medicine in the appropriate state
  • Board Certification in Medical Oncology or Hematology by American Board of Internal Medicine.
  • Demonstrated knowledge of current practice standards in specialty
  • 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 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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