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 Newtown Square, Pennsylvania, 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 .

Job Summary

The Medical Director, Medicare, reporting to the Medicare CMO, provides medical leadership in Population Health (PH) to the Medicare Business (MC) in areas such as care management (CM), utilization management (UM), Pharmacy and Quality, to advance business objectives and improve the health of our member population. The MDM is responsible for the overall care and activities supporting the member population and Plan, applying clinical and administrative leadership skills to guide care and quality initiatives/performance, coordinating with stakeholders, and aligning with providers. The MDM drives improvement in CM, UM and quality outcomes as a change leader.

Responsibilities:

• Drives performance at the member and population level in Plan care management and quality (Stars and state-based withholds).

• Analyzes information to develop interventions that improve quality of care and outcomes.;

• Supports quality processes and structures such as QOC reviews, committees, and policies.

• Leads CM interdisciplinary rounds identifying available Plan interventions to improve care outcomes including closure of quality care gaps and prevention of unnecessary admissions.

• Provides clinical guidance to CM including LTSS duals and ensures follow through.;

• Follows and delivers the Model of Care.;

• Renders decisions and supports processes to be member-centered, and aligned with Plan objectives, addressing clinical and non-clinical needs and health equity in all functions. Engenders trust.;

• Provides leadership and interventions to address MLR including utilization, trend management, and implementation of actions to ensure appropriate, cost-effective, efficient care. Identifies and leads initiatives that drive value and supports provider alignment. Reviews medical trend and offers data-driven recommendations and follow-through. Works with UM, Pharmacy and CM to address utilization.

• Supports and upholds regulatory requirements, compliance, policies and contractual agreements, and mitigates risk. Knowledgeable on policies, contracts, government mandates or other requirements with clinical, operational, and financial impact.

• Enables Plan growth through member satisfaction/retention and new market implementations.

• Supports the MC CMO needs and delivers timely, completed assignments as directed. Tracks and meets key performance indicators of PH and MC.

• Other duties as assigned.

Education/Experience:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

• Valid, active and unrestricted medical license. Must obtain licensure in all markets upon hire. Must not be prohibited from participating in any Federally or State funded healthcare programs

• Active Board certification in area of specialty.

• Adult Primary care discipline with a minimum of 3 years of full-time medical practice experience.

• 3+ years of full-time equivalent leadership experience in Medicare managed care or health system equivalent with direct experience in quality performance and care management.

• Outcome and member focused, excellent team leadership and communication skills.

• Mission-guided, passion for helping members.

• Demonstrated healthcare improvement and change management success.

• Works effectively in teams, building trust and rapport, collaborative with interdisciplinary contributions.

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.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.