Medical Director, MVP Health Care, (Job ID: 1167)

Posted: 01/16/18 | SHARE:

Description:

MVP Health Care is a nationally-recognized, regional not-for-profit health plan.  We are committed to having a positive impact on the health and wellness of everyone and every community we serve. We care for more than 700,000 members across New York and Vermont, and we are powered by the ideas and energy of more than 1,600 employees – providing a wide range of health benefit plan options with attentive service and flexibility normally associated with a smaller company.  Stop settling for “just a job,” and join a company where you can reach your full potential…and make a positive difference!

 

JOB SUMMARY:

The Medical Director provides clinical expertise and timely clinical determinations based on MVP’s policies/procedures, benefits interpretations, clinical criteria and medical necessity. The Medical Director provides clinical case reviews. They also provide second level medical review of appeals as mandated by state law and required to meet accreditation standards. Conveys to participating providers, MVP policy on medical management and collaborates with providers to resolve network issues. As directed by the Vice President of Medical Affairs, the Medical Director makes timely visits to individual physicians and medical groups in order to discuss outpatient and inpatient practice variability and to discuss outstanding quality concerns. As directed by the Vice President of Medical Affairs, the Medical Director settles hospital dispute resolutions with respect to inpatient admission and bed days. The Medical Director works collaboratively on utilization concerns and seeks guidance from the Vice President of Medical Affairs. The Medical Director identifies and implements initiatives to promote appropriate utilization. The Medical Director provides support to Network Management, sales and marketing, and attends MVP committee meetings as assigned. They support and communicate effectively with MVPs Quality Improvement, Pharmacy, Health Promotions, and Disease Management Programs. The Medical Director attends meetings as assigned. The Medical Director actively participates in MVP training and medical directors meetings and conference calls. The Medical Director, on a rotational basis, provides coverage outside of normal business hours. Also performs other tasks as assigned by management. Performs other duties as assigned. 

 

 

 

 

Qualifications:

Minimum Education:
Licensed to practice medicine in New York State. Board Certified, preferably in a surgical or primary care specialty.

 

Minimum Experience:
Minimum of 5 years post residency practice experience is required, including significant exposure to practicing in a managed care environment.

Previous experience as a medical director in a managed care/health plan is desirable

 

Required Skills:
• Experience with critical review in clinical scenarios is desirable.

• Knowledge of and experience with NCQA requirements and HEDIS reporting is desirable.

• Strong organizational, communication, and writing skills are essential.

• Ability to communicate effectively with physicians in practice and facility staff is essential.

• Travel throughout MVP Health Care’s Service area is required.

• Ability to effectively use the computer is essential.

• Ability to critically evaluate and research the medical literature is essential.

Additional Information:

MVP Health Care is an Affirmative Action/Equal Opportunity Employer). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency, protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

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