VP, Medical Management & Health Informatics

RCM Health Care Services; New York (NY); Hybrid; USD 360,000 - 380,000; Full time

Job summary

RCM Healthcare Services is seeking a Vice President of Medical Directors for a direct-hire leadership role with a major health plan in New York City. The VP will lead medical management, with emphasis on Utilization Management, health informatics, and regulatory compliance, reporting to the Chief Medical Officer.

The role blends clinical oversight with data-driven policy and strategic planning across multiple lines of business. Excellent communication and NY regulatory experience are essential.

Qualifications

• MD or DO from an accredited medical school.
• Minimum 3 years of clinical experience post-residency.
• Minimum 5 years in a managed care/health plan setting.
• At least 3 years overseeing Utilization Management.
• Experience with health informatics or healthcare data analytics.
• Demonstrated knowledge of healthcare regulatory compliance.
• Experience with New York State regulations and compliance preferred.

Responsibilities

• Provide physician leadership across medical management functions, focusing on Utilization Management (UM).
• Review complex cases, determine medical necessity, advise on length of stay, level of care, and reimbursement documentation.
• Support UM staff and Care Managers with concurrent review and preauthorization referrals.
• Provide clinical expertise for member and provider appeals and collaborate with senior clinical leadership for UM operations.
• Help develop health informatics and data capabilities to support decision-making.
• Participate in clinical policy review and regulatory policy changes.
• Contribute to strategic planning for existing and expanding health plan business.
• Represent the organization at regulatory and industry meetings with NYS/NYC agencies.
• Partner with the CMO on medical management strategy and priorities.

Skills

Leadership

Utilization Management

Health informatics

Regulatory compliance

Healthcare data analytics

Executive communication

Education

MD or DO degree

Board Certification

Job description

RCM Healthcare Services is seeking a Vice President of Medical Directors for a direct-hire leadership role with a major health plan in New York City. The VP will lead medical management, with emphasis on Utilization Management, health informatics, and regulatory compliance, reporting to the Chief Medical Officer.

The role blends clinical oversight with data-driven policy and strategic planning across multiple lines of business. Excellent communication and NY regulatory experience are essential.