Senior Medical Director Value Based Care
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Job Summary
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.
Education/Experience:
MBA, MPH, MHA, or MMM preferred.
Current unrestricted medical license.
Board certification.
5+ years physician leadership experience.
10+ years managed care, value-based care, or health plan leadership experience.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
For roles that are 100% remote or hybrid, you 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. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We’re looking for the next generation of health care leaders.
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 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.
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