• Medical Director

    AmeriHealth CaritasSouthfield, MI 48086

    Job #1220226669

  • Medical Director Location: Southfield, MI Telecommuter?: No ID**: 19034 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 Philadelphia, 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 ~~~ . Responsibilities: Provide organizational leadership in the operational areas of utilization review, case management, quality improvement and related policy and practice initiatives. Incumbent will serve as the physician liason for the Plan working closely with other medical management team members. Assists in the development and implementation of medical policy, including recommendations for modifications to enhance efficiency and effectiveness. Assures compliance with medical policy. Maintains compliance with all federal, state and local regulatory guidelines. Directs the efforts of the utilization review, case management, and pre-certification functions to accomplish objectives within policy and budget. Performs daily medical reviews. Oversees the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes and ensure proper provision for participants. Education/Experience: + Medical degree (M.D. or D.O.) + Must have unrestricted licensed to practice in the state(s) assigned as a medical director/doctor and recognized by the proper licensing authority. Active MI license required + Must be Board-certified in his/her medical specialty. + Must be clear of any sanctions by the applicable state or Office of the Inspector General. + Must not be prohibited from participating in any Federally or State funded healthcare programs + 2+ years full-time experience practicing medicine. + 3+ years in on or a combination of the following: + Full-time experience as an administrator in a Medicare or state-level Medicaid program, Health Maintenance Organization (HMO), Preferred or + Full-time medical facility administration or medical facility management experience + 5+ years of medical management and general management experience in a managed care environment is preferred. + Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred. + Utilization management experience preferred that should include appeals. Long Term Services & Support (LTSS) preferred. + Licensure in multiple states highly desired EOE Minorities/Females/Protected Veterans/Disabled

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