Position: Vice President, Medical Management

Location: Hybrid (Must Reside in NY/NJ/CT)

Job Type: Exempt - Full Time

Compensation: $275,075.69 - $305,639.65

JOB SUMMARY:

The Vice President for Medical Management at VillageCareMAX is a board-certified physician who will serve as the physician lead for Medical Management functions which includes Utilization Management, Care Management, population health management initiatives, and engagement with VCMAX's network of physicians and other practitioners. The Vice President for Medical Management will possess the skills and capabilities needed to develop and execute medical cost management and health care quality and affordability initiatives. The Vice President for Medical Management provides the physician leadership for engagement with risk-sharing groups, works with providers on collaborative quality initiatives, leads clinical initiatives to promote health and well-being of the membership, establishes and leads best practice and education forums, and responds to state and federal regulatory needs as needed.

The Vice President for Medical Management will support VCMAX in key external meetings, work with the Compliance Department and Special Investigations Unit on cases of potential overuse and fraud and participate in development of responses for escalated member or provider issues as appropriate.

The Vice President for Medical Management, in collaboration with the Utilization Management Leadership, will have responsibility for organizational determinations, prior authorization requests, and member and provider appeals. All medical directors and physician advisors will report directly to this position. The Vice President of Medical Management reports to the Executive Vice President, Clinical Services and Network Management.

EXPERIENCE:

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

EDUCATION:

Must have a medical degree from an accredited medical school, be board certified in at least one area, and have an unrestricted license to practice medicine in New York State