Vice President, Medical Director of Clinical Programs

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🎰 Nevada, Maryland, +3 more states – Remote

🎰 Nevada – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🏰 Missouri – Remote 🍁 Vermont – Remote

⏰ Full Time

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👨‍⚕️ Medical Director

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• 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