Vice President, Medical Management

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.

Responsibilities

• Serve as the physician lead for Utilization Management, Care Management, population health management initiatives, and engagement with VCMAX's network of physicians and other practitioners.
• Develop and execute medical cost management and health care quality and affordability initiatives.
• Provide physician leadership for engagement with risk-sharing groups, collaborate with providers on quality initiatives, lead clinical initiatives to promote health and well-being, establish and lead best practice and education forums, and respond to regulatory needs.
• Support VCMAX in key external meetings, work with the Compliance Department and Special Investigations Unit on cases of potential overuse and fraud, and participate in developing responses for escalated member or provider issues.
• Collaborate with the Utilization Management Leadership to make organizational determinations, handle prior authorization requests, and manage member and provider appeals.
• Report directly to the Executive Vice President, Clinical Services and Network Management.

Requirements

Minimum of ten (10) years of experience, including both clinical practice and management roles, ideally including experience working in a managed care organization or accountable care organization.

Qualifications

All lines of business, Medicaid, MLTC, Medicare (all sub product lines).

Skills

Experience working in a managed care organization or accountable care organization, medical degree from an accredited medical school, board certification in at least one area, and an unrestricted license to practice medicine in New York State.

Pay

$275,075.69 - $305,639.65 per year

Schedule

Hybrid (Must reside in NY/NJ/CT)