Vice President, Medical Director of Clinical Programs
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Vice President Medical Director managing clinical programs and directing medical teams at Martin's Point Health Care. Driving healthcare quality and compliance in a not-for-profit organization.
Responsibilities:
- 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
- Lead 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 HP 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 Point 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 related 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 HP leader aligning medical, clinical, and operational functions to achieve seamless and thorough solutions related 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 complex 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 HP/provider arrangements.
- Excellent interpersonal communication and problem-solving skills
- Proficient with Microsoft Office applications (Outlook, Word, Excel, 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 make 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 develop relationships with network and community physicians and other providers
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Able to educate and promote best practices within medical and clinical care programs
- Able to lead, develop and manage a physician team
Benefits:
- health insurance
- paid time off
- wellness programs
Similar Jobs
Medical Director
Senior clinician leading medical work for clinical trials at HealthMatch. Overseeing EMR reviews, collaborating with engineering, and providing strategic medical leadership.
Medical Director, Behavioral Health – Medicaid
Behavioral Health Medical Director managing strategies and operations for Medicaid services at Humana. Ensuring compliance and collaboration across teams and stakeholders.
Medical Director – Commercial
Medical Director at CVS Health overseeing and expanding Aetna's medical management programs. Ensuring clinical quality and effective healthcare resource use across member needs.
Field Medical Director
Field Medical Director engaging with health care practitioners on ImmunityBio products and facilitating clinical research. Responsible for integration of scientific expertise and relationship management with KOLs.
Scientific Partnership Medical Director
Scientific Partnership Medical Director leading enterprise medical strategy for oncology at BeOne. Engaging with healthcare leaders and coordinating medical resources in the U.S.
Head – Scientific Partnership Medical Director
Head, Scientific Partnership Medical Director overseeing oncology networks and health systems engagement at BeOne Medicines. Leading a team to drive strategic partnerships in a senior medical role.
Area Director of Clinical Operations, North Florida
Area Director of Clinical Operations managing and supporting clinical staff across various locations in Florida. Collaborating with area leadership to ensure high standards in oncology care and operations.
Group Medical Director
Group Medical Director overseeing veterinary operations and patient safety to drive quality care across VCA hospitals. Managing and mentoring medical directors while ensuring high standards of veterinary practice.
Group Medical Director
Group Medical Director leading veterinary care, ensuring high-quality standards in VCA hospitals. Mentoring Medical Directors and enhancing patient safety through collaboration and leadership.
Group Medical Director
Group Medical Director overseeing high-quality veterinary care and clinical excellence across VCA hospitals. Leading medical teams and enhancing patient safety initiatives throughout the organization.
Group Medical Director – Specialty
Group Medical Director managing veterinary care quality and safety. Leading teams and ensuring evidence-based practices across VCA hospitals while fostering collaboration and team development.
Associate Medical Director – UM PT
Associate Medical Director ensuring clinical accuracy and oversight of UM programs at Independent Health. Collaborating with teams to support clinical program development and HEDIS initiatives.
Enterprise Medical Director
Enterprise Medical Director leading clinical care standards development and implementation at CareSource. Ensuring compliance with national quality standards and supporting medical leadership in operational roles.
Senior Medical Director – Rheumatology, Medical Affairs
(Senior) Medical Director providing strategic medical leadership for rheumatology products at Sobi. Leading execution of US medical strategies and engaging HCPs and stakeholders.
Senior Medical Director – Rheumatology, Medical Affairs
Senior Medical Director at Sobi managing medical affairs for rheumatology products and engaging healthcare providers. Leading strategic initiatives and research efforts for ultra-rare disease treatments.
Medical Director
Medical Director leading clinical oversight and utilization management for Home Health, DME, Home Infusion Therapy, and Sleep Medicine. Conducting medical necessity reviews and collaborating with health plan leadership.
Senior Medical Director – YouthCare
Senior Medical Director leading medical affairs for Illinois Health Plan at Centene Corporation. Overseeing medical leadership and quality improvement activities for Medicaid and Medicare members.
Health Systems Oncology Medical Affairs Director
Health Systems Oncology Medical Affairs Director responsible for developing relationships with healthcare decision makers. Collaborates on strategic account planning and provides medical information regarding oncology products.
Senior Medical Director, Radiopharmaceutical Imaging
Senior Medical Director overseeing radiopharmaceutical imaging with strategy and operational leadership in cancer therapy development. Leading cross-functional teams to drive imaging portfolio success.
System Medical Director – Vice President of Pathology Services
System Medical Director & VP for Pathology Services leading clinical path services at Bon Secours Mercy Health laboratories. Ensuring quality and regulatory compliance across all sites while driving service excellence and organizational goals.