Regional Vice President overseeing account management and clinical guidance for national clients at Elevance Health. Collaborating with sales and account management teams to enhance healthcare quality and outcomes.
About the role
- Medical Director ensuring clinical determinations and enhancing care quality at MVP Health Care. Collaborating with teams to improve health care delivery in New York.
Responsibilities
- Render first- and second-level clinical determinations based on medical necessity criteria, MVP policies, and regulatory guidelines
- Collaborate with Utilization Management, Case Management, and Appeals teams to enhance care quality and service utilization
- Support implementation of quality improvement initiatives in a matrixed environment
- Identify and execute strategies to promote medication adherence, care management, and cost containment
- Participate in Medical Director training sessions, meetings, and conference calls
- Provide transactional coverage outside normal business hours on a rotational basis, including weekends
- Perform other duties as assigned
Requirements
- MD or DO with current, unrestricted licensure in any U.S. state
- Eligible for licensure in New York and Vermont
- Board certification in an ABMS-recognized primary care or specialty discipline
- Minimum 10 years of clinical practice with demonstrated leadership experience
- At least 3 years in a managed care environment preferred
- Experience with post-acute care initial and appeal determinations is preferred
- Strong organizational, communication, and writing skills for functioning in a highly matrixed environment
- Ability to communicate effectively with physicians, practice staff, and facility personnel
- Proficiency in computer systems and electronic documentation
- Ability to critically evaluate and research medical literature
- Knowledge of quality improvement programs (HEDIS, STAR, CAHPS measures) preferred
- Familiarity with NCQA requirements
Benefits
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
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