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AmeriHealth Caritas Medical Director in Philadelphia, Pennsylvania

Medical Director

Location: Philadelphia, PA

Telecommuter?: No

ID**: 17854

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

Responsibilities:

  • Under the direction of the CMO, provide clinical leadership and support for Quality Improvement programs, as well as meeting or exceeding all regulatory requirements

  • Collaborate with CMO, Dual Special Needs Plan and engage all functional areas of MLTSS from a clinical perspective to develop case management and innovative services; serving as the primary clinical liaison with Network Services, Marketing, Operations, Information Systems, Pharmacy, and Utilization Management.

  • As CHC expands its membership, motivate and mentor clinical and LTSS staff by 'setting the pace' and fostering 'excellence by example'.

  • Collaborate with physicians to develop clinical programming by accessing and mining clinical data, devising methods to manage populations. Partner with physicians to improve reimbursement model and performance based physician incentive programs.

  • Influence medical cost trend in partnership with network services, utilization and case management teams, including development of trend-specific initiatives, provider fee schedule review, and identification of medical management best practices. Create opportunities to integrate pharmaceutical and medical strategy with innovative solutions.

  • Serve on physician committees and work with each program to monitor, assess and ensure the program's clinical success.

Education/Experience:

  • MD/DO.

  • Unrestricted License in Pennsylvania.

  • Five to 10 years of practice experience, with a minimum of five years of practice experience in his or her specialty.

  • Post residency clinical experience.

  • Experience in Health Service treatment and program development.

  • At least five years of management experience preferred.

  • Experience in managed care setting preferred.

  • Ability to implement medical policies, and to enforce those policies through appropriate action.

  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care. Ability to implement programs of quality care analysis, peer review, and professional education.

  • Board Certification in ABMS American Board or Medical Specialists preferred.

EOE Minorities/Females/Protected Veterans/Disabled

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