Utilization Management Director jobs in New York

Join VillageCare as a Part-Time Medical Director and be part of a team that values excellence and integrity in healthcare. This exciting opportunity offers hybrid flexibility of working from home, making it an ideal position for a skilled Physician seeking a perfect work-life balance. This is a Part-time position that is regularly scheduled to work a minimum of 20 hours per week. The bulk of work will be in the afternoons. Availability Monday through Friday from 1:00pm-5:00pm will be required. With a competitive salary range of $130,000-$150,000, you can further your career in a customer-centric and forward-thinking organization that prioritizes high performance and professionalism. You can get great benefits such as a PTO package, Holiday Pay, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), and more! Apply now and take the next step in your career with VillageCare!

WHO ARE WE? AN INTRODUCTION

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.

MAKE A DIFFERENCE AS A MEDICAL DIRECTOR

The Medical Director role at VillageCareMAX is a crucial position responsible for overseeing clinical operations within the Utilization Management Department. Working closely with the Senior Medical Director, this role plays a key part in directing medical management activities and ensuring quality improvement initiatives are implemented effectively. From providing oversight on utilization management services to developing impactful strategies for inpatient reviews and out-of-network coordination, the Medical Director contributes significantly to the organization's goal of delivering cost-effective and quality healthcare services.

By actively participating in case rounds and maintaining compliance with regulatory standards, the Medical Director plays a vital role in ensuring the seamless delivery of care to members. Collaborating with the Finance Department and serving as Co-Chair of the Credentialing Committee will be vital to this role.

DOES THIS SOUND LIKE YOU?

To excel in the role of Medical Director at VillageCareMAX, candidates must possess 3-5 years of experience in health plan operations, particularly in medical management within Medicare and Medicaid Programs such as MLTC, MAP, DSNP, and MAPD. Proficiency in inpatient and outpatient utilization management for medical and pharmacy services is essential, along with prior experience in conducting appeal reviews. Familiarity with the NY Market and a clean record free of any affiliations with New York-based groups or hospitals are also prerequisites for this position. Additionally, candidates should have a strong grasp of healthcare software and tools to effectively document case reviews and analyze utilization patterns for continuous improvement in medical management practices. A Medical Doctorate is required for this position, Master's Degree in public health is also preferred. Current and unrestricted Physician license to practice in NY. Preferred: Board Certified, preferably internal medicine or geriatrics.

READY TO JOIN OUR TEAM?

If you think this job aligns with your requirements, then submitting an application is simple. Good luck!