Medical Director

6 days ago


Manchester, New Hampshire, United States AmeriHealth Caritas Full time
About the Role

AmeriHealth Caritas is seeking a highly skilled Medical Director to lead our Substance Abuse Disorder and Behavioral Health programs. As a key member of our leadership team, you will be responsible for providing clinical oversight and direction for our SUD and BH components.

Key Responsibilities
  • Design and implement programs in compliance with federal and state laws and contractual requirements.
  • Provide local physician review of SUD and BH treatment requests.
  • Make recommendations regarding ACNH utilization management programs based on member and provider needs and feedback.
  • Oversee the quality of clinical care for network and non-network providers.
  • Engage the provider network in Continuous Quality Improvement through the diffusion of practice standards.
  • Review and resolve disputes related to the quality of care.
  • Assure a high-performing Utilization Management system that adheres to the coverage terms and requirements of the contract.
  • Serve as the primary external subject matter expert for ACNH for SUD and BH.
  • Lead the development and implementation of contractually required clinical programs.
Requirements
  • MD required.
  • Valid NH medical license; board certification in psychiatry and addiction psychiatry preferred.
  • Board Certified Addictionologist in New Hampshire.
  • Must have unrestricted licensed to practice in the state(s) assigned as a medical director/doctor and recognized by the proper licensing authority.
  • Must be clear of any sanctions by the applicable state or Office of the Inspector General.
  • Must not be prohibited from participating in any Federally or State funded healthcare programs.
About AmeriHealth Caritas

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience delivering 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.

We are committed to equity and inclusion, and we strive to create a workplace where everyone can feel valued, supported, and comfortable to be themselves. We put these principles into action every day by acting with integrity and respect.

We offer a comprehensive benefits package, including flexible work solutions, competitive pay, paid time off, health insurance coverage, and more.


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