Medical Director AHNJ
- M.D. (medical doctor) or D.O. (doctor of osteopathy) degree from a medical school or osteopathic medical school recognized by the American Association of Medical Colleges (AAMC), the American Osteopathic Association (AOA) or the World Health Organization (WHO).
- Completion of an accredited residency program in a program accredited by the Liaison Committee of Graduate Medical Education (LCGME) or the AOA.
- Unrestricted and unencumbered New Jersey and Pennsylvania licenses to practice clinical medicine or osteopathic medicine.
- Current, active Board Certification by a member Board of the American Board of Medical Specialties (ABMS) or a recognized Board of the Osteopathic Medical Association.
- Operational knowledge of the application of utilization review criteria and guidelines; CPT/HCPCS, ICD-9/10 and DRG coding; health insurance benefits administration and physician and hospital managed care contracting.
- Good standing with federal and state health care benefits programs, including Medicare, Medicaid and Federal Employee Health Benefits Program. No unresolved disciplinary actions precluding participation in such programs.
- No history of conviction for insurance fraud or related offense in any state.
-
Ability to use standard computing tools including email, Microsoft Office and other business applications necessary to complete assigned tasks.
-
Utilization management experience preferred.
-
Successful completion of AHNJ’s credentialing process.
-
Must possess strong interpersonal, verbal, and written communications skills.
-
Ability and willingness to travel to the following locations:
-
AHNJ’s corporate office in Cranbury, NJ (primary location).
-
Provider offices and hospital systems throughout the state.
-
Independence corporate headquarters in Philadelphia, PA (on a very limited basis).
-
Diversity, Equity, and Inclusion
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
AmeriHealth is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.