Market CMO

AmeriHealth Caritas • Newtown Square, PA • 28min ago

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, 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 .

Role Overview

The Market Chief Medical Officer (CMO) is a member of the market leadership team and reports directly to the CHC Market President/CEO and has a dotted line reporting relationship to the National Chief Medical Officer. The position is responsible for market-based clinical leadership including the development and execution of all health care affordability and clinical quality initiatives to achieve goals.

The Market CMO is accountable for quality initiatives to improve HEDIS, pay-for-performance, LTSS and other quality measures and ratings, and collaborates with the local provider community and state regulatory agencies to improve care and strengthen relationships with all external parties.

As part of the market leadership team, the CMO contributes meaningfully to all areas of health plan performance, including service coordinator staff development.

The Market CMO is a seasoned professional who engages externally with the Plan's stakeholders to advance clinical excellence and the delivery of cost-efficient care while building a network of supportive partners.

Work Arrangement:

Monday through Friday, 8:30 AM EST to 5:00 PM EST with 2 to 3 days per week in our office in Harrisburg, PA or Newtown Square, PA

Candidates local to Greater Philadelphia area are preferred

Responsibilities:

Strategic and Clinical Leadership: Provides leadership for CHC LTSS medical management initiatives

Utilization Management (UM): Ensures a high-performing UM system that follows the Covered Services specified in the Contract and uses evidence-based standards for coverage determinations

Quality, Governance and Medical Oversight: Provides physician leadership for quality governance and quality-of-care reviews

Regulator Engagement and Clinical Escalation Support: Serves as the Plan's primary physician-level contact for the regulator's Medical Director

Medical Policy and Compliance: Oversees medical policy development and regulatory compliance

Provider Network and Community Engagement: Supports provider network quality, adequacy and access

Cross-Functional Collaboration: Collaborates with medical management, network contracting and provider relations, member services, claims management and payment integrity, pharmacy, and quality and risk adjustment

External Stakeholder Engagement: Engages members, the physician community and health systems, nursing facilities and home and community-based networks, professional associations, and government and advocacy groups to advance clinical excellence and cost-efficient care.

Education and Experience:

Minimum of five (5) years of active clinical practice in a medical specialty such as OBGYN, Pediatrics, Internal Medicine, Family Practice, or a surgical discipline.

At least five (5) years of progressive leadership in medical management is required. Prior experience as a Medical Director or Chief Medical Officer within a managed care organization is preferred.

Proven ability to lead clinical, quality, and operational teams in direct and matrixed environments.

Experience working across multiple lines of business, including Medicaid, Medicare, and ACA/Exchange.

Experience with quality improvement methodologies (e.g., IHI, Lean, Six Sigma).

Licensure:

Must hold an active and unencumbered license to practice medicine in Pennsylvania

Valid driver's license and car insurance.

Skills and Abilities:

Demonstrated knowledge of the health needs of diverse, low-income populations.

Strong decision-making skills with the ability to develop and execute strategic initiatives.

Advanced analytical capabilities with a focus on population health and cost-of-care outcomes.

Excellent verbal and written communication skills, with the ability to clearly convey complex clinical and operational concepts.

Ability to build effective relationships across all levels of the organization, including providers, regulatory agencies, and internal stakeholders.

Skilled in leveraging technology and data analytics to support clinical and operational performance.

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.

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