Market Chief Medical Officer
AmeriHealth Caritas
- Atlanta, GA
- Permanent
- Full-time
- Ensuring Members receive the appropriate covered medical services.
- Setting up standard medical practices and crafting clinical rules and processes.
- Actively involved in all major clinical program components of the Services.
- 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
- conduct, neglect, etc.
- Lead provider performance and engagement; responsible for managing provider relationships.
- State regulator relationship & accountability to clinical requirements both contractual and directed by regulator.
- 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.
- This position is physically required to reside in Georgia.
- Board Certified Physician or Doctor of Osteopathy degree.
- An unrestricted license to practice medicine in the Plan’s state and any other state in which he/she works.
- Valid driver’s license.
- 3+ years of office experience.
- Must have 5-10 years healthcare experience.
- 5+ years of practice experience in his/her area of specialty.
- 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). Access is a plus.
- Consistent word processing speed and accuracy of 50 or more words per minute.