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Commercial Product Performance Management Medical Director

Company: MVP Health Care
Location: Schenectady
Posted on: May 24, 2023

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.
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 :

  • Ability to lead staff effectively to achieve cohesive team operation and optimum performance
  • Knowledge of utilization and care management operations and alignment of these operational areas with other key stakeholders is preferred
  • Strong organizational, communication, and writing skills for function in a highly matrixed environment are essential
  • Ability to communicate effectively with physicians in practice and facility staff is essential.
  • Ability to effectively use the computer is essential.
  • Ability to critically evaluate and research the medical literature is essential.
    Preferred Skills :
  • Knowledge of quality improvement including HEDIS, STAR, CAHPS measures is preferred.
  • Knowledge of and experience with NCQA requirements is desirable.
    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
    Please apply and learn more - including how you may become a proud member of our team.
    Other details
  • Job Family Medical Management/Clinical
  • Pay Type Salary

Keywords: MVP Health Care, Schenectady , Commercial Product Performance Management Medical Director, Executive , Schenectady, New York

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