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Medical Director, Provider Network Practice Transformation job in Philadelphia at Amerihealth

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Medical Director, Provider Network Practice Transformation at Amerihealth

Medical Director, Provider Network Practice Transformation

Amerihealth Philadelphia, PA Full Time
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Job Brief

Physician responsible for the transformation of provider contracts

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 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 [ Link removed ] - Click here to apply to Medical Director, Provider Network Practice Transformation.


Primary key accountabilities of the job: Reporting to the SVP, Network Management , the Medical Director, Provider Practice Transformation is responsible for the transformation of provider contracts, with an increased shift toward value-based payments and risk-based arrangements and transformation of practice behaviors and activities in new and existing markets.  In collaboration with the VP, Provider Performance, this leader will develop new concepts that the Provider Performance team will model for viability and future implementation.  Leveraging the corporate portfolio of VBP/APM models, the Medical Director, Provider Practice Transformation partners with market executives and oversees the development and implementation of work plans and strategies for all new and existing markets.     

This position leads the Practice Transformation team resources and, through matrixed relationships, operationalizes payment strategies and practice support programs across all markets. Advancement of our strategy will be evidenced by meeting or exceeding state or regulatory VPB goals and measurable change in provider behaviors and processes that improve member outcomes. 

Major Accountabilities:

Team oversight 

  • Sets strategic direction for practice transformation, develops implementation plans, oversees Practice Transformation Managers in their practice transformation activities and collaborates across the enterprise to align efforts in support of market-facing activities. 
  • Ensures team’s expertise is continually updated to state-of-the-art levels as relates to understanding and application of how information is captured and analyzed, which data analysis techniques are best for various situations, and how to use data to improve performance.

Operationalize Innovation

  • Partners with the Provider Performance team to evaluate new payment structures.  Works with network management to implement a portfolio of value-based compensation models and programs that can/will be used across the enterprise.
  • Creates and ensures an ongoing infrastructure for continuous improvement for all provider participants across the enterprise. Team will use this infrastructure to identify and develop suggestions for provider participants’ improvement plans and assist providers in developing, implementing, monitoring, and tracking of improvement activities.  Strengthens provider performance monitoring and profiling to create high value/performance networks.
  • Engages, trains, and educates market Practice Transformation resources to influence meaningful and measurable change impacts.  Ensures process for monitoring of staff expertise is in place.
    Directly engages physician practices in transformation activities.

Analytics and Reporting

  • Ensures appropriate data and analytic tools are identified and used to support practice improvement plans and to ensure VBP/APM goals are met, or exceeded.  Analyzes and ensures appropriate performance evaluation of strategic provider partnerships. 
  • Reports at the executive level on metrics that measure achievement of program goals and forecasts future trends and actions needed.  Establishes strong provider performance monitoring and profiling to capture necessary data.  Manages the monitoring of key performance indicators for programs


Education/ Experience:

  • A medical degree (M.D. or D.O.).
  • Must be Board-certified in his/her medical specialty.
  • 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.
  • 5+ years of medical management and general management experience in a managed care environment is preferred.
  • Minimum of 10 years of business experience to include Value Based contracting and strategy setting. 
  • Minimum of Five years of experience in a senior leadership position to include high profile MCO customer engagement experience with in-depth experience in value-based partnership contracting and with risk bearing provider groups.

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Job ID: PGM-CC-7055_21209

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