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Market Chief Medical Officer

Company: AmeriHealth
Location: Raleigh
Posted on: July 15, 2019

Job Description:

Job Brief Market Chief Medical Officer 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. This position is contingent upon an award of new business Responsibilities:

The Market Chief Medical Officer provides oversight of all utilization review techniques and methods and their administration and implementation. He or she is directly responsible for all clinical activities, including but not limited to the proper provision of covered services to members, developing clinical practice standards, and clinical policies and procedures. The position is responsible for the execution of all health care affordability and clinical quality initiatives to achieve goals. The Market CMO is accountable for ACFC quality initiatives to improve HEDIS and other quality ratings and will have substantial involvement in QAPI Program Activities. The Market Chief Medical Officer is a seasoned professional who faces outward to and interacts with the Plan's membership and physician community, physician and health system networks, medical/physician professional associations, government representatives, and advocacy groups to advance clinical excellence and the delivery of cost efficient care. Education and Experience: Education/Experience:

  • Medical Degree (M.D. or D.O.)
  • 5+ years of medical management and general management experience in a managed care environment is preferred.
  • Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred.
  • Utilization management experience preferred. Minimum five years of progressive business experience.
  • Must be licensed to practice in the state(s) assigned as a medical director/doctor and recognized by the proper licensing authority.
  • Must be Board-certified in his/her medical specialty.
  • Must be clear of any sanctions by the applicable state or Office of the Inspector General.
  • Must not be prohibited from participating in any Federally or State funded healthcare programs.
  • 5+ years Full time experience practicing medicine
  • 3+ years in on or a combination of the following:
  • Full-time experience as an administrator in a state-level Medicaid program, Health Maintenance Organization (HMO), Preferred
  • Provider Organization (PPO), large Health Care Organization, health plan or any combination thereof
  • Full-time medical facility administration or medical facility management experience.

Keywords: AmeriHealth, Raleigh , Market Chief Medical Officer, Executive , Raleigh, North Carolina

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