Medicare Value-Based Care Executive

Univera HealthСare in; City of Rochester (NY); Hybrid; USD 250,000 - 375,000; Full time

Job summary

Univera Healthcare in Rochester, NY seeks a Senior Medical Director for Medicare & Value-Based Payment (Finance) to lead clinical and business strategy across value-based care, population health and medical management. You will partner with line of business leaders, network and provider contracting, actuarial, finance, quality, and analytics to improve outcomes and total cost of care.

The role requires an MD/DO with NY license, 3+ years as Medical Director, strong analytical and communication

Qualifications

• MD/DO with NYS license and board certification.
• 3+ years as Medical Director for a health plan or equivalent.
• Strong analytical and financial acumen with CMS/quality familiarity.

Responsibilities

• Serve as senior clinical advisor to line of business on strategy, population health, quality, and regulatory priorities.
• Translate data into actionable clinical and operational priorities to improve outcomes and cost of care.
• Establish provider performance expectations, scorecards, and improvement strategies.
• Provide clinical leadership for medical management programs and care coordination.
• Collaborate with Quality to monitor key metrics and lead quality improvement initiatives.
• Ensure compliance with CMS, NYS, NCQA requirements and evolving payment methods.
• Perform appeals and case reviews on claims and pre-authorization requests.

Skills

Influence physicians and executives

Analytical and financial acumen

Verbal and written communication

Education

MD/DO with NYS medical license

Board certification

Job description

Univera Healthcare in Rochester, NY seeks a Senior Medical Director for Medicare & Value-Based Payment (Finance) to lead clinical and business strategy across value-based care, population health and medical management. You will partner with line of business leaders, network and provider contracting, actuarial, finance, quality, and analytics to improve outcomes and total cost of care.

The role requires an MD/DO with NY license, 3+ years as Medical Director, strong analytical and communication