Senior Medical Director Value Based Care

Amerihealth Caritas•,

2d•Remote

About The Position

The Senior Medical Director, Value Based Care is a high-level physician executive responsible for developing and executing enterprise strategies that optimize healthcare value, improve affordability, and reduce medical expense while maintaining excellence in quality, member outcomes, provider experience, and regulatory compliance. This executive serves as the enterprise clinical leader for Health Value Optimization (HVO), clinical policy governance, payment integrity, healthcare economics, medical cost management, and vendor performance oversight. Lead the clinical approach to enterprise HVO strategy and annual value creation targets. Provide executive oversight of clinical policy development and Medical Policy Committee governance. Serve as physician executive sponsor for payment integrity programs and clinical claims review strategy. Partner with Network Management to develop high-value provider and value-based contracting strategies. Provide executive oversight of clinical and medical management vendors and governance structures. Serve as physician advisor to Government Affairs, Legal, and Compliance on regulatory and legislative matters. Lead enterprise medical expense management initiatives and affordability programs. Work Arrangement: Fully Remote with preference of candidates being in Eastern or Central US time zones. Executive Scope Enterprise Health Value Optimization strategy. Clinical Policy governance and oversight. Medical expense trend management. Payment Integrity clinical strategy. Vendor governance and value realization. Network value strategy and provider performance optimization. Medical economics partnership. Government affairs, legal and regulatory clinical consultation. Enterprise affordability initiatives.

Requirements

Current unrestricted medical license.
Board certification.
5+ years physician leadership experience.
10+ years managed care, value-based care, or health plan leadership experience.
Must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

Nice To Haves

MBA, MPH, MHA, or MMM preferred.

Responsibilities

Lead the clinical approach to enterprise HVO strategy and annual value creation targets.
Provide executive oversight of clinical policy development and Medical Policy Committee governance.
Serve as physician executive sponsor for payment integrity programs and clinical claims review strategy.
Partner with Network Management to develop high-value provider and value-based contracting strategies.
Provide executive oversight of clinical and medical management vendors and governance structures.
Serve as physician advisor to Government Affairs, Legal, and Compliance on regulatory and legislative matters.
Lead enterprise medical expense management initiatives and affordability programs.