VP Medical Directors — Policy, Data & Utilization

MetroPlusHealth; New York (NY); Vor Ort; USD 250.000 - 350.000; Vollzeit

Zusammenfassung

MetroPlusHealth in New York is seeking a Vice President of Medical Directors to lead medical management, utilization, and data-driven policy across plans. The role collaborates with physicians, care managers, and regulatory bodies to ensure high-quality, compliant care.

You will build health informatics capabilities, guide technology assessments, and shape strategic planning while representing the plan at state and city health departments.

Qualifikationen

• MD/DO degree from an accredited medical school.
• Minimum 3 years clinical experience post-residency.
• Minimum 5 years in managed care with at least 3 years overseeing Utilization Management.
• Experience with health informatics, data sciences and regulatory compliance.

Aufgaben

• Reviews cases to determine medical necessity and consults with physicians to review length of stay and reimbursement documentation.
• Supports Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals.
• Works with the VP of Clinical Services who oversees day-to-day UM operations.
• Provides clinical support for members and provider appeals.
• Builds a health informatics function and ensures decisions are made according to data insights.
• Assists in new technology assessment and clinical policy review as required.
• Responsible for implementation of ongoing changes in policy and procedures from state and government entities.
• Participates in the development of strategic planning for existing and expanding business.
• Represents the health plan at regulatory meetings held by NYS Department of Health and NYC Department of Health and Mental Hygiene.
• The VP of Medical Directors will be required to come to MetroPlusHealth HQ once a week (preferably on Thursdays).
• Performs other duties as needed and assigned by the Chief Medical Officer

Kenntnisse

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

Ausbildung

Doctor of Medicine or Doctor of Osteopathic Medicine

Jobbeschreibung

MetroPlusHealth in New York is seeking a Vice President of Medical Directors to lead medical management, utilization, and data-driven policy across plans. The role collaborates with physicians, care managers, and regulatory bodies to ensure high-quality, compliant care.

You will build health informatics capabilities, guide technology assessments, and shape strategic planning while representing the plan at state and city health departments.