Market Clinical Director - Population Health

AmeriHealth Caritas - Manchester, NH

Full-time
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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 Market Clinical Director, Population Health is responsible for market specific clinical operations supervising all UM, ICM, and RROT staff and ensuring all market activities conform to enterprise program descriptions, policies and procedures.

Oversight of execution of market specific clinical programs including UM, CM, RROT, and Bright Start.
Assures compliance of program execution with enterprise policies.
Monitors performance metrics across multiple LOBs and assures that appropriate action is taken to address performance opportunities consistent with enterprise policies.
Responsible for market specific contract and accreditation compliance related to Population Health Clinical Operations.
Supervises market specific Population Health Clinical Operations staff.

Requirements:
Three to five years’ experience of progressive management experience (including staff management) in a managed care environment.
Experience with managed Medicaid clinical programs highly desirable.
Proven management experience with case management and utilization management programs preferred.
Prior experience in case management and utilization management program design, implementation preferred. Should include experience in setting, communication and implementing strategic direction.
Bachelor’s degree required in Nursing or healthcare related field.
Master’s degree preferred or equivalent work related experience.
New Hampshire clinical license is required, RN is preferred.
LCSW or BH equivalent advanced licensure may be considered.
CCM certification preferred and will be required within 2 years of hire.
Candidate must reside in New Hampshire as onsite presence is required.