Job Description

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.

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Position Summary:

Provide organizational leadership in the operational areas of care management, utilization review, appeals, quality improvement and related policy and practice initiatives related to Behavioral Health in collaboration with the Corporate Medical Director, Behavioral Health.

The following responsibilities are in regard to working with members diagnosed with mental illness and substance abuse conditions and their providers:

• Utilizes evidence-based standards in making coverage determinations
• Identifies and implements evidence-based practice guidelines throughout the provider network
• Monitors the quality of clinical care provided by in network and non-network providers
• Utilizes a high-performing medical management system that adheres to the terms of contracts and all relevant regulatory requirements. ;

; Accountabilities:

• ;Ensures the provision of quality and clinically sound behavioral health care services to all members by associates and providers
• ;Serves as medical advisor ;for all behavioral health clinically related activities
• ;Assures that organizations medical policies and procedures adhere to contractual obligations;
• ;Performs clinical case reviews in conjunction with Medical Excellence Department responsible for HEDIS performance
• ;Maintains familiarity with federal, state and local regulations that may pertain to the medical and clinical operations
• ;Supports leadership in the development and implementation of medical policy as it relates to behavioral health management
• ;Maintains compliance with applicable regulatory guidelines, AmeriHealth Caritas clinical policies and procedures, and contractual obligations
• ;Works closely with a multidisciplinary team to ensure behavioral health management and quality management programs are meeting contractual obligations
• ;Works with the leadership of the Quality Improvement and Medical Excellence departments to develop competent clinical staff
• ;Trains staff on behavioral health-related issues and provide consultation to staff as appropriate
• ; Assists IHC Managers in assessing members’ need for case management services
• ; Attends case management meetings and monthly rounds as scheduled
• ; Collaborates with the integrated case management team, during scheduled meetings and informally as needed
• ; Thoroughly documents all care coordination activity in the member medical record in the electronic medical management system
• ; Adheres to AmeriHealth Family of Companies (ACFC) policies and procedures and supports and carries out the ACFC mission and values
• ; Other duties as assigned.;;

Experience/Education

• Board certified psychiatrist licensed in the District of Columbia or ability to be licensed in District of Columbia.;
• Physician licensed to practice medicine and specialty in addiction medicine.;
• 5-10 years practical clinical experience combined experience in a Behavioral Health Clinical setting required
• Must not be prohibited from participating in any Federally or State funded healthcare programs
• Must be clear of any sanctions by the applicable state or Office of the Inspector General

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Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

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 $220,100 and $364,200.

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