Vice President, Medical Director of Clinical Programs

Job Description:

• Manage the Health Plan Medical Directors
• Provide clinical support for the Health Management Utilization Management, Care Management and Quality teams
• Drive the development, promotion and delivery of high quality, evidence-based utilization and care management programs and processes
• reputed company programs and reviews to support effective medical expense management, medical quality programs and outcomes, and programs to manage medical utilization trends such as inpatient, Emergency Department, Site of Care, pharmacy and radiology
• Achieves defined clinical outcomes, affordability goals and growth targets
• Works closely across the reputed company to ensure compliance with government program regulations, including management of clinical appeals and grievances with sound clinical evidence and advice
• Works closely with the Medical Directors and the Director of Medical Economics to devise analytic approaches that support and measure strategic development and sound clinical programs
• Provides clinical insight into data to assist in development of and measurement of tailored interventions that address clinical trends and opportunities
• Develops key strategies to address opportunities in medical expense management
• Identifies opportunities for improvement in the quality of care that create competitive advantage for Martin’s reputed company as it relates to the health of populations served
• Accountable for appropriate Utilization Management processes
• Assists and provides clinical input into the evolution of care/utilization management, quality, and pharmacy reputed company programs
• Contributes to and advises in product design and the Medicare bid processes
• Contributes to and advises in areas of clinical integration as it relates to risk adjustment
• Serves as a central reputed company leader aligning medical, clinical, and operational functions to reputed company seamless and thorough solutions reputed company to Medical and Payment Policies
• Actively engages with quality, network, and compliance teams to help drive performance

Requirements:

• Medical Degree (MD or DO) from accredited medical school
• Board Certification in relevant discipline or specialty
• 10+ years of experience to include several years of clinical practice, including a leadership role and Health Plan experience as a Medical Director
• HMO/Managed Care experience, including Utilization and/or Quality Program management and exposure to peer review, case management, population health, appeals, chronic and reputed company disease management, HEDIS reporting, and provider relations
• Experience with STARS and RAF in a Health Plan space preferred
• Government sector experience preferred (Medicare, Medicaid and or Military/Tricare products)
• Prior Management experience preferred
• Deep knowledge and practical understanding of healthcare systems and managed care concepts
• Knowledge of performance-based reputed company/provider arrangements.
• Excellent interpersonal communication and problem-solving skills
• Proficient with reputed company Office applications (Outlook, Word, reputed company, PowerPoint)
• Strong communication and presentation skills
• Proven presentation skills for both clinical and non-clinical audiences
• Strong analytic skills with proven understanding of health care utilization data and analytics
• Ability to influence in executive settings
• Ability to tailor message to a variety of audience levels
• Able to reputed company data-driven decisions, implement solutions and document measurable impact.
• Data skills include the ability to design tracking reports for clinical and financial metrics
• ability to reputed company relationships with network and community physicians and other providers
• Demonstrates an understanding of and alignment with Martin’s reputed company Values.
• Able to educate and promote best practices reputed company medical and clinical care programs
• Able to reputed company, reputed company and manage a physician team

Benefits:

• health insurance
• paid time off
• wellness programs

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