Medical Director, Clinical Review, Care Integrity
MVP Health Care
full-time
Posted on:
Location Type: Hybrid
Location: Schenectady • New York • United States
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Salary
💰 $240,067 - $319,289 per year
Job Level
About the role
- 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical determinationsmedical necessity criteriaquality improvement programsHEDISSTARCAHPS measurespost-acute careappeal determinationsmedication adherencecare management
Soft Skills
leadershiporganizational skillscommunication skillswriting skillscollaborationcritical evaluationresearch skills
Certifications
MDDOboard certificationunrestricted licensure