Commercial Product Performance Management Medical Director
Company: MVP Health Care
Location: Schenectady
Posted on: May 24, 2023
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Job Description:
Commercial Product Performance Management Medical Director
Headquarters Office, 625 State Street, Schenectady, New York,
United States of America Req #1358
Wednesday, March 15, 2023
Over 35 years strong and fueled by 1,700 smart, passionate
employees across New York state and Vermont, MVP is full of
opportunities to grow. We are a nationally recognized,
award-winning leader for a reason. The beating heart of our company
is a wide range of employees from a diverse set of backgrounds-tech
people, numbers people, even people people-working together to make
health insurance better. If you are ready to join a thriving,
mission-driven company where you can create your own opportunities
and make a positive difference-it's time to make a healthy career
move to MVP!
Develop subject matter expertise in all relevant components
necessary to ensure Commercial and ASO product success. The
Commercial Product Performance Management Medical Director is r
esponsible for ongoing analysis of current performance against
historical data, competitor benchmarks, and against budget. Leads
the optimization of line of business specific product performance
including utilization and cost trends, quality activities and
performance, and risk adjustment as appropriate. Responsible for
[in coordination with network, actuary, risk adjustment, quality,
utilization and case management teams, as well as other key
individuals] developing and implementing interventions to mitigate
adverse performance.
The Commercial Product Performance Management Medical Director p
rovides clinical expertise and support for key accounts. Leads
clinical oversight of vendor activity and performance as it relates
to MVP's Commercial/ASO membership. Provides clinical expertise and
timely first and second level clinical determinations based on
MVP's policies/procedures, state and federal guidelines, national
accreditation standards, benefits interpretations, and other
medical necessity criteria as necessary.
Commercial Product Performance Management Medical Director supports
MVP's efforts to enhance business discipline of and collaboration
between Utilization Management, Case Management, Appeals and other
divisions of the Health Management Department to improve clinical
outcomes across all business lines. Supports Medical Operations
efforts to implement and execute Quality initiatives in a highly
matrixed environment. Identifies and implements initiatives in
collaboration with other senior leaders to promote appropriate care
quality, service utilization, medication utilization and adherence,
care management, and cost control. T hrough matrixed leadership
supports other key stakeholders such as sales and marketing,
quality, operations, and others. Supports effective matrix
alignments with other key stakeholders to drive Medical Operations
programming.
Actively participates in MVP training and medical directors'
meetings and conference calls. Provides transactional coverage
outside of normal business hours on a rotational basis, including
weekends. Performs other duties as assigned. Location near one of
MVPs administrative New York or Vermont state locations preferred
(Schenectady, Rochester, Tarrytown); telecommuting opportunities
will be considered for candidates with previous successful
telecommuting management experience. Requires ability to travel
during normal business hours and afterhours as needed.
POSITION QUALIFICATIONS
Minimum Education:
Current unrestricted licensure (MD or DO) in any US state Eligible
for licensure (MD or DO) in New York State and Vermont Board
Certified in any ABMS-certified primary care or specialty
practice
Minimum Experience:
Minimum of 5 years in clinical practice with evidence of leadership
excellence; 3 years of experience in a managed care environment
preferable
Required Skills :
Preferred Skills :
About MVP
MVP Health Care is a nationally recognized, not-for-profit health
insurer caring for more than 700,000 members in New York and
Vermont. Committed to the complete well-being of our members and
the communities we serve, MVP makes health insurance more
convenient, more supportive, and more personal. We are powered by
the ideas and energy of more than 1,700 diverse, employees from all
backgrounds, committed to having a positive impact on the health
and wellness of everyone we serve. MVP Health Care is an
Affirmative Action/ Equal Employment Opportunity (PDF). 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 (PDF),
and the Know your Rights 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
Please apply and learn more - including how you may become a proud
member of our team.
Other details
Keywords: MVP Health Care, Schenectady , Commercial Product Performance Management Medical Director, Executive , Schenectady, New York
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