Position must be located in Louisville, KY. Responsible for the administration of medical services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies of the business unit. Primary duties may include, but are not limited to: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company. May chair or serve on company committees. May be required to represent WellPoint to external entities and/or serve on external committees.
Requires MD; 10 years of experience with extensive managed care or Medicare knowledge; or any combination of education and experience, which would provide an equivalent background. Board certification required where applicable to the duties being performed. Knowledge of Utilization Management, Case Management, or Disease Management is preferred. Ability to do some sales calls is preferred.
Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).
associate referral process on WorkNet. Official guidelines for the associate referral
- Current WellPoint associates: All referrals must be submitted through the formal
program can be found in My HR.
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