AmeriHealth Caritas

Role Overview:

The Market Chief Medical Officer (CMO) reports directly to the Market President. The position is responsible for overall market clinical and population health strategy and operations oversight, supporting market-based clinical leadership, and enabling execution of all clinical, population health, and quality initiatives to achieve goals within the plan. The Market CMO is accountable for population health management strategy, quality, clinical, and total cost of care initiatives.

The Market CMO is a clinical executive responsible for interacting with the plan membership, community, provider, health system networks, professional associations, and District regulatory agencies to advance clinical excellence and the delivery of cost and operationally efficient care.

Responsibilities:

• Experience in leadership and oversight of segment leaders and strategic direction of clinical, quality, and population health programs across care management, utilization management, quality, and value-based care.
• Experience in using data analysis to identify opportunities for medical cost trend and quality improvement to positively influence member and total cost of care outcomes.
• Support the development and implementation of medical policy, including maintaining compliance with regulatory guidelines and recommended modifications to improve efficiency and effectiveness.
• Market thought leader for the internal organization, external providers, and regulatory (local, state, and federal) and accrediting agencies.
  
  

Work Arrangement:

• Hybrid - Must be able to work in the District office 4 days a week.
• Travel to local providers, governmental offices, and the community.
  
  

Education and Experience:

• A minimum of Five (5) years of clinical practice experience in their specialty (e.g., Internal Medicine, Family Practice, Medical or Surgical).
• A minimum of Five (5) years of progressive medical management leadership is required. Managed care organization leadership experience as a Medical Director or CMO is preferred.
• Demonstrated ability to lead clinical, quality, and business leaders in a direct and matrixed environment.
• Experience working with multiple business product lines, i.e., Medicaid, Medicare, ACA/Exchange.
• Experience and/or knowledge of the health needs of diverse, low-income populations is required.
• Experience with quality improvement methodologies (IHI, Lean, Six Sigma), population health management approaches, and medical trend and economics experience.
• Demonstrated ability to make strategic decisions.
• Strong analytical and population health skills required.
• Strong verbal and written communication skills required.
• Interpersonal skills: ability to interact effectively and professionally with all levels within the plan and enterprise organizations, providers, other managed care organizations, and the state and regulatory agencies.
• Able to use and apply technology and analytics to support outcomes.
  
  

Licensure:

• The Chief Medical Officer (CMO) must possess a current unrestricted license and be board-certified to practice medicine in the District.
  
  

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are 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 would like to connect with 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.

The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington D.C. area. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training. AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more. The targeted hiring range for this role is expected to be between $243,200 and $401,300.