Medical Direction, Medical Director Job at MVP Health Care
Medical Direction, Medical Director
Headquarters Office, 625 State Street, Schenectady, New York, United States of America
Headquarters Office, 625 State Street, Schenectady, New York, United States of America
- Rochester Office, 220 Alexander Street, Rochester, New York, United States of America
- Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America
- Vermont, USA Req #1276
Tuesday, October 11, 2022
Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP!
Full Time, Exempt
MEDICAL DIRECTOR - MEDICAL POLICY:
Provides clinical expertise and timely first and second level clinical determinations based on MVP's policies/procedures, state and federal guidelines, national accreditation standards, benefits interpretations, and other medical necessity criteria as necessary. Supports MVP's efforts to enhance business discipline of and collaboration between Utilization Management, Case Management, Appeals and other divisions of the Health Management Department to improve clinical outcomes across all business lines. Supports Medical Operations efforts to implement and execute Quality initiatives in a highly matrixed environment. Identifies and implements initiatives in collaboration with other leaders to promote appropriate care quality, service utilization, medication utilization and adherence, care management, and cost control.. Actively participates in MVP training and medical directors' meetings and conference calls. Provides transactional coverage outside of normal business hours on a rotational basis, including weekends. Performs other duties as assigned. Location near one of MVPs administrative New York state locations preferred (Schenectady, Rochester, Tarrytown); MVP hybrid model is utilized. Requires ability to travel during normal business hours and afterhours as needed.
POSITION QUALIFICATIONS
Minimum Education:
Current unrestricted licensure (MD or DO) in any US state Eligible for licensure (MD or DO) in New York State and Vermont Board Certified in any ABMS-certified primary care or specialty practice
Minimum Experience:
Minimum of 10 years in clinical practice with evidence of leadership excellence; 3 years of experience in a managed care environment preferable
Required Skills:
- Strong organizational, communication, and writing skills for function in a highly matrixed environment are essential
- Ability to communicate effectively with physicians in practice and facility staff is essential.
- Ability to effectively use the computer is essential.
- Ability to critically evaluate and research the medical literature is essential.
Preferred Skills:
- Knowledge of quality improvement including HEDIS, STAR, CAHPS measures is preferred.
- Knowledge of and experience with NCQA requirements is desirable.
About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
Please apply and learn more - including how you may become a proud member of our team.
Other details- Job Family Medical Management/Clinical
- Pay Type Salary
Apply Now
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- Ability to communicate effectively with physicians in practice and facility staff is essential.
- Ability to effectively use the computer is essential.
- Ability to critically evaluate and research the medical literature is essential. Preferred Skills:
- Knowledge of quality improvement including HEDIS, STAR, CAHPS measures is preferred.
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- Headquarters Office, 625 State Street, Schenectady, New York, United States of America
- Rochester Office, 220 Alexander Street, Rochester, New York, United States of America
- Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America
- Vermont, USA
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