Senior Medicare Value-Based Care Leader

Capital District Physicians Health Plan Inc; Town of De Witt (NY); Hybrid; USD 250,000 - 375,000; Full time

Job summary

Capital District Physicians Health Plan Inc in New York seeks a Senior Medical Director to lead value-based care, population health, medical management, and quality improvement across lines of business. You will partner with network, contracting, actuarial, finance, analytics, and operations to improve outcomes, member experience, and total cost of care.

The role requires NY licensed MD/DO, board certification, 3 years as Medical Director, and strong analytical, financial, and communication

Qualifications

• Strong analytical and financial acumen with the ability to connect clinical interventions to medical expense and revenue.

Responsibilities

• Serve as senior clinical advisor to line of business leadership on strategy, population health, medical cost, quality, and regulatory priorities.
• Identify clinical and market opportunities to improve member outcomes and competitive performance.
• Establish provider performance expectations and improvement strategies.
• Provide clinical leadership for medical management programs to optimize site of care and reduce high-cost services.
• Partner with Quality leadership to monitor quality metrics and value-based purchasing results.
• Apply CMS, NYS, NCQA requirements and other regulations to support business areas.

Skills

Influence cross-functional teams

Analytical and financial acumen

Verbal, written and interpersonal

Managed care understanding

Education

MD/DO with NY license

Board certification

Job description

Capital District Physicians Health Plan Inc in New York seeks a Senior Medical Director to lead value-based care, population health, medical management, and quality improvement across lines of business. You will partner with network, contracting, actuarial, finance, analytics, and operations to improve outcomes, member experience, and total cost of care.

The role requires NY licensed MD/DO, board certification, 3 years as Medical Director, and strong analytical, financial, and communication