AmeriHealth Caritas Medical Director in Charleston, South Carolina

Medical Director


Description

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:

  • 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 for participants.

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.
  • 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), Preferred

  • Provider Organization (PPO), large Health Care Organization, health plan or any combination thereof
  • Full-time medical facility administration or medical facility management experience.

EOE Minorities/Females/Protected Veterans/Disabled