Senior Medicare Value-Based Care Leader

Capital District Physicians Health Plan Inc; City of Rochester (NY); Híbrido; USD 250.000 - 375.000; Jornada completa

Descripción de la vacante

Capital District Physicians Health Plan Inc. seeks a Senior Medical Director to lead strategic clinical initiatives across value-based care, population health, medical management, and quality improvement.

The role partners with line of business leadership, contracting, finance, analytics, and operations to improve outcomes, member experience, provider performance, and total cost of care in compliance with CMS requirements.

Formación

• MD or DO with an active NYS medical license, board certified.
• Three (3) years as Medical Director for a health plan or equivalent.
• Ability to influence physicians, providers, executives, and cross-functional teams.
• Experience with value-based arrangements (MA) such as shared savings/risk/capitation.
• Strong analytical and financial acumen relating clinical interventions to medical expense and revenue.
• Strong verbal, written and interpersonal communication.
• Understanding of managed care structures and CMS/NY/NCQA requirements.

Responsabilidades

• Provide strategic clinical leadership for medical management programs (utilization management, prior authorization, case management, care coordination).
• Develop strategies to optimize site of care and reduce avoidable inpatient admissions and high-cost services.
• Partner with quality and operational leaders to improve preventive care and quality measures.
• Monitor performance against quality metrics, PMPM trends, and risk-adjusted performance.
• Perform appeals and case reviews on claims and pre-authorization requests.

Conocimientos

Strategic leadership

Analytical thinking

Communication

Educación

MD or DO with NY license

Descripción del empleo

Capital District Physicians Health Plan Inc. seeks a Senior Medical Director to lead strategic clinical initiatives across value-based care, population health, medical management, and quality improvement.

The role partners with line of business leadership, contracting, finance, analytics, and operations to improve outcomes, member experience, provider performance, and total cost of care in compliance with CMS requirements.