Market Chief Medical Officer - Atlanta, GA, United States - AmeriHealth Caritas

Description

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.

Together we can build healthier communities.

We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

The position is responsible for market-based clinical leadership and 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 collaborates with the local provider community and state regulatory agencies to improve care.

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.

Ensuring Members receive the appropriate covered medical services.
Setting up standard medical practices and crafting clinical rules and processes.
Responsible for the sufficiency and supervision of the Provider Network, and ensure compliance with federal, state, and local reporting laws on communicable diseases, childhood abusive

Lead provider performance and engagement; QAPI chair, lead CQI process and assure quality focus and compliance by plan; support regulator quality initiatives.

Credentialing Committee lead maintaining quality of care standards by network providers.
Clinical policy review and authorship of new policy requirements.
Support Medical Management and local UM decisions, including appeals, grievances, OON and SCA, covered benefits.
Advise provider network team and support plan VBP/APM strategy and programming.
Clinical advisor for CM, BH, UM, Pharmacy rounds.
Support community engagement an activation.
An unrestricted license to practice medicine in the Plan's state and any other state in which he/she works.
~ 3+ years of office experience.
~ Must have 5-10 years healthcare experience.
~5+ years of medical management and general management experience in a managed care environment is required.
~ Proficiency with Microsoft Office Suite (Word, Excel, Power Point). Diversity, Equity, and Inclusion

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.

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.

#