Senior Medical Director, Care Management & Quality

EmblemHealth, Inc.; New York (NY); Remote; USD 189,000 - 362,000; Full time

Job summary

EmblemHealth in New York is looking for a physician leader to manage the daily clinical operations of the Medical Management Department, coordinating internal and external stakeholders to promote high-quality care.

The role focuses on improving utilization across Internal Medicine, OB/GYN, Psychiatry, Ambulatory Medicine, Emergency Medicine and Radiology, while ensuring compliance with DOH, CMS, NCQA, and URAC standards.

Qualifications

• MD or DO degree required with board certification.
• Active New York or Connecticut license to practice medicine without restriction.
• Minimum 5 years of clinical practice.
• Administrative experience in hospital committee, medical group, or insurer preferred.
• Knowledge of clinical practice, healthcare delivery systems, utilization methods and treatment protocols.
• Understanding of managed care principles, physician reimbursement, and HR management.
• Independent decision making with physicians, members, subordinates and regulatory agencies.
• Strong communication skills (oral and written).
• Familiarity with high risk populations and care of medical patients.

Responsibilities

• Manage daily clinical operation and administration of the Medical Management Department.
• Lead care management to improve utilization results across specialties.
• Serve as liaison among Senior Management, Plan staff, providers, vendors and members.
• Ensure compliance with Department of Health, Department of Insurance, CMS, NCQA and URAC standards.
• Develop and implement new policies and programs as needed.
• Oversee policies, workflows, and processes to ensure consistency and efficiency.
• Generate methods to improve the overall delivery and performance of the department.
• Represent Care Management in interdepartmental committees and contract negotiations as needed.

Skills

Communication skills

Independent decision making

Clinical leadership

Education

MD or DO degree

Board certification

Active NY or CT medical license

Job description

EmblemHealth in New York is looking for a physician leader to manage the daily clinical operations of the Medical Management Department, coordinating internal and external stakeholders to promote high-quality care.

The role focuses on improving utilization across Internal Medicine, OB/GYN, Psychiatry, Ambulatory Medicine, Emergency Medicine and Radiology, while ensuring compliance with DOH, CMS, NCQA, and URAC standards.