Vice President Medical Director – Clinical Programs

🕒 il y a 2 mois

🦞 Maine, Nevada, +3 états de plus – Distant

🦞 Maine – Remote 🎰 Nevada – Remote 🦀 Maryland – Remote 🏰 Missouri – Remote 🍁 Vermont – Remote

⏰ Temps Plein

🔴 Expert

👨‍⚕️ Directeur Médical

👻 Score fantôme 43%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Martin's Point Health Care

Site WebLinkedInTous les Emplois

501 - 1000 employés

🛡️ Assurance

📦 Logistique

💼 Conseil

Insurance • Logistics • Consulting

Martin's Point Health Care est une organisation de soins de santé engagée à servir ses communautés locales à travers des services de soins primaires et spécialisés de haute qualité. L'organisation met un fort accent sur la création d'une culture de travail positive, la reconnaissance des contributions des employés et la promotion de la diversité de la main-d'œuvre. Martin's Point Health Care offre une gamme d'opportunités de carrière dans divers départements, allant des prestataires de soins de santé aux rôles d'entreprise, et soutient la croissance des employés grâce à une rémunération compétitive, des programmes de développement et des avantages généreux. De plus, l'entreprise est reconnue pour ses efforts d'impact communautaire, levant des fonds significatifs pour des organisations communautaires et encourageant le bénévolat des employés.

Description

• Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development • Partner with Health Plan senior leadership to advance clinical outcomes, affordability goals, growth targets, and overall health plan strategy • Lead cross-functional collaboration among Medical Directors, Medical Economics, Quality, Network, Compliance, Pharmacy, Operations, and Clinical Programs • Support compliance with government program requirements, including clinical appeals and grievances, using sound clinical evidence and medical judgment • Use clinical, quality, utilization, and financial data to identify trends, assess performance, and recommend actionable interventions • Develop strategies to improve medical expense management, appropriate utilization, quality of care, and population health outcomes • Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives • Communicate complex clinical, regulatory, and operational information clearly to executive, provider, clinical, and non-clinical audiences • Support appropriate utilization of services through strong partnership with Utilization Management, Care Management, and physician leaders • Represent the organization with regulatory entities, professional societies, providers, network partners, and external stakeholders, as appropriate • Build and strengthen relationships with hospitals, physicians, and other health care providers to support network engagement and performance goals • Support strategies tied to population health, care management, provider performance, and contractual outcomes • Lead, support, and develop physician leaders and clinical team members, as assigned

🎯 Exigences

• Medical Degree, MD or DO, from an accredited medical school • Board certification in a relevant medical discipline or specialty • Active, unrestricted medical license, or ability to obtain licensure in a state relevant to the role • Ten or more years of professional experience, including clinical practice experience • Health plan, managed care, or payer experience in a Medical Director or comparable physician leadership role • Demonstrated experience working across health plan functions, such as utilization management, care management, quality, appeals and grievances, population health, medical economics, provider relations, pharmacy, compliance, or network • Experience using clinical, quality, utilization, or financial data to guide decisions, develop interventions, and measure outcomes • Strong cross-functional leadership skills, with the ability to align clinical, operational, financial, and regulatory priorities • Strong verbal, written, and presentation skills, including the ability to communicate effectively with executive, clinical, provider, operational, and regulatory audiences • Ability to influence, collaborate, and build credibility with internal and external stakeholders • Strong analytical, problem-solving, and decision-making skills • Demonstrated alignment with Martin’s Point Health Care values.

🏖️ Avantages

• Health insurance • 401(k) matching • Paid time off • Flexible working arrangements • Professional development opportunities