- Behavioral Health Medical Director
- Population Health Director
- Integrated Care Management Director
- Utilization Management Liaison
- Quality Director
- Experience in leadership and oversight of segment leaders and strategic direction of clinical, quality, and population health programs across care management, utilization management, quality, and value based care
- Experience in using data analysis to identify opportunities for medical cost trend and quality improvement to positively influence member and total cost of care outcomes
- Support development and implementation of medical policy, including maintaining compliance with regulatory guidelines and recommendations for modifications to improve efficiency and effectiveness
- Market thought leader for the internal organization, external providers, and regulatory (local, state and federal) and accrediting agencies
- Current and unrestricted MD or DO license to practice medicine in Ohio and any other state in which he/she works.
- Board certified in his/her area of specialty.
- A minimum of 5 years of clinical practice experience in his/her area of specialty (e.g. Internal Medicine, Family Practice, Medical or Surgical).
- A minimum of 5 years of progressive medical management leadership is required. Managed care organization leadership experience as a Medical Director or CMO role preferred.
- Demonstrated ability to lead clinical, quality, and business leaders in a direct and matrixed environment.
- Experience working with multiple product lines of business, i.e. Medicaid, Medicare, ACA/Exchange.
- Experience with quality improvement methodologies (IHI, Lean, Six Sigma), population health management approaches, and medical trend and economics experience.
- Demonstrated ability to make strategic decisions.
- Strong analytical and population health skills required.
- Strong verbal and written communication skills required.
- Interpersonal skills: ability to interact effectively and professionally with all levels within the plan and enterprise organizations, providers, other managed care organizations, and the state and regulatory agencies.
- Able to use and apply technology and analytics to support outcomes.
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Market Chief Medical Officer - Dublin, OH, United States - RPMGlobal
Description
Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are 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 would like to connect with you.
Headquartered in Newtown Square, 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
The Market Chief Medical Officer (CMO) reports directly to the Enterprise Population Health CMO and has a dotted line matrix reporting relationship to the Market President. The position is responsible for overall market clinical and population health strategy and operations oversight, supporting market-based clinical leadership, and enabling execution of all clinical, population health, and quality initiatives to achieve goals within the plan. The Market CMO is accountable for population health management strategy, quality, clinical, and total cost of care initiatives.
The Market CMO is clinical executive who is responsible for and interacts with the plan membership, community, provider and health system networks, professional associations, and state regulatory agencies to advance clinical excellence and the delivery of cost and operationally efficient care.
Direct reports of the Market CMO currently include:
The Market CMO role is remote, but the candidate must live in Ohio and have an active Ohio medical license in good standing. The role will require intermittent travel to health plan offices in Dublin, OH (suburb of Columbus, OH), state regulator offices in Columbus, OH, and providers across the state, expecting travel up to weekly.
Primary Responsibilities & Accountabilities:
Education/ Experience :
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
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