Vice President, Medical Management

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.

About the role

The Vice President for Medical Management at VillageCareMAX is a board-certified physician who will serve as the physician lead for Medical Management functions, including Utilization Management, Care Management, population health management initiatives, and engagement with VCMAX's network of physicians and other practitioners. This role develops and executes medical cost management, health care quality, and affordability initiatives.

The Vice President for Medical Management provides physician leadership for engagement with risk-sharing groups, collaborates with providers on quality initiatives, leads clinical programs to promote member health, establishes best-practice forums, and ensures compliance with state and federal regulations. This role supports external meetings, works with Compliance and Special Investigations on potential overuse or fraud cases, and assists in resolving escalated member or provider issues.

In collaboration with Utilization Management Leadership, this position oversees organizational determinations, prior authorization requests, and member/provider appeals. All medical directors and physician advisors report directly to this role. The Vice President of Medical Management reports to the Executive Vice President, Clinical Services and Network Management.

Responsibilities

• Lead Medical Management functions, including Utilization Management, Care Management, and population health initiatives.
• Develop and execute medical cost management, quality, and affordability strategies.
• Engage with risk-sharing groups and collaborate with providers on quality improvement initiatives.
• Lead clinical programs to promote the health and well-being of members.
• Establish and lead best-practice and education forums for providers.
• Ensure compliance with state and federal regulatory requirements.
• Support key external meetings and represent VCMAX as needed.
• Work with Compliance and Special Investigations on cases of potential overuse or fraud.
• Assist in resolving escalated member or provider issues.
• Oversee organizational determinations, prior authorization requests, and appeals in collaboration with Utilization Management Leadership.
• Supervise all medical directors and physician advisors.

Requirements

• Minimum of ten (10) years of experience, including both clinical practice and management roles, ideally in a managed care organization or accountable care organization.
• Experience across all lines of business: Medicaid, MLTC, and Medicare (all sub-product lines).
• Medical degree from an accredited medical school.
• Board certification in at least one area.
• Unrestricted license to practice medicine in New York State.

Pay

$275,075.69 - $305,639.65

Hybrid role; must reside in NY, NJ, or CT.