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
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 .
Provide organizational leadership in the operational areas of
utilization review, case management, quality improvement and
related policy and practice initiatives. Incumbent will serve as
the lead physician for the Plan working closely with other medical
management team members. Assists in the development and
implementation of medical policy, including recommendations for
modifications to enhance efficiency and effectiveness. Assures
compliance with medical policy. Maintains compliance with all
federal, state and local regulatory guidelines. Directs the efforts
of the utilization review, case management, and pre-certification
functions to accomplish objectives within policy and budget.
Performs daily medical reviews.
Oversees the quality management function in the identification
and analysis of medical information to develop interventions to
improve quality of care and outcomes and ensure proper provision
Medical degree (M.D. or D.O.)
Must have unrestricted licensed to practice in the state(s)
assigned as a medical director/doctor and recognized by the proper
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
2+ years full-time experience practicing medicine.
3+ years in on or a combination of the following: Full-time
experience as an administrator in a Medicare or state-level
Medicaid program, Health Maintenance Organization (HMO),
Provider Organization (PPO), large Health Care Organization,
health plan or any combination thereof, or
Full-time medical facility administration or medical facility
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
Minimum 5 years of progressive business experience.