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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 network physicians and practitioners. This role involves developing and executing medical cost management and healthcare quality and affordability initiatives, providing physician leadership for engagement with risk-sharing groups, and collaborating with providers on quality initiatives.

Responsibilities

Serve as the physician lead for Medical Management functions.
Develop and execute medical cost management and health care quality and affordability initiatives.
Provide physician leadership for engagement with risk-sharing groups.
Work with providers on collaborative quality initiatives.
Lead clinical initiatives to promote health and well-being of the membership.
Establish and lead best practice and education forums.
Respond to state and federal regulatory needs.
Support VCMAX in key external meetings.
Work with the Compliance Department and Special Investigations Unit on cases of potential overuse and fraud.
Participate in development of responses for escalated member or provider issues.
Have responsibility for organizational determinations, prior authorization requests, and member and provider appeals.
Oversee all medical directors and physician advisors.

Requirements

Minimum of ten (10) years of experience, including both clinical practice and management roles.
Experience working in a managed care organization or accountable care organization.
Experience with all lines of business: Medicaid, MLTC, Medicare (all sub product lines).

Skills

Skills and capabilities needed to develop and execute medical cost management and health care quality and affordability initiatives.

Location

Hybrid (Must Reside in NY/NJ/CT)

Work Type

Hybrid
Full Time

Experience Level

10+ years of experience

Education Level

Medical degree from an accredited medical school
Board certified in at least one area
Unrestricted license to practice medicine in New York State

Salary/Compensations

$275,075.69 - $305,639.65

About the Company

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.