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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 www.amerihealthcaritas.com.
The VP Utilization Management Physician is responsible for oversight and execution for all utilization management policies and processes, contributing to a whole person care approach to serve members. This role provides physician leadership to a multidisciplinary team responsible for utilization management, prior authorization, behavioral health reviews and appeals.
This role will identify opportunities for actions to improve the health of members and lower costs. This leader will apply expertise in developing and utilizing key performance indicators to identify and investigate complex problems in various health care domains across several problem spaces. This leader will also deliver results on high-impact projects collaborating with various stakeholders and will identify opportunities for next best actions to improve processes and lower costs.
A successful leader will perform well in a fast-paced environment, will have an operational mindset with attention to detail, and will focus on identifying value to challenging business problems. This position requires strong business acumen, exceptional communication skills, and the ability to make complex concepts simple and easy to understand.
- Develop clinical protocols and policies to enhance the quality of medical decision-making, incorporating input from a variety of stakeholders.
- Monitor performance of team to ensure appropriate resource allocation and process efficiency.
- Provide timely medical reviews, drive clinical improvement, help educate and lead the clinical staff on matters involving utilization.
- Provide clinical determinations based on evidence-based criteria and guidelines.
- MD required.
- Board Certified and Licensed to practice medicine without restrictions.
- 10 or more years experience in senior management and or Medical Director experience; 7 years Utilization Review and Case management experience.
- Experience with Managed Medicaid programs highly desirable.
- Management experience with Case Management and Utilization management programs.
- Strong business acumen and an operational mindset.
- Attention to detail.
- Exceptional communication skills.
- Ability to work in a fast paced environment.