VP, Medical Director - Physical Health
Posted on Apr 8, 2019 by Magellan Health
o Interfaces with National and State medical leadership, both in standing meetings and as needed, to discuss emerging issues, improvement in metrics, and strategic plans.
o Provides medical leadership, oversight, consultation and supervision for the designated business unit region including the National and Local Quality Improvement (QI) Program and Utilization Management (UM) Program.
o Provides strategic direction and implementation assistance for Disease and Care Management programs nationally.
o Identifies clinical trends and best practices and partners with Operations Clinical SVP and/or VP and other cross functional teams to develop and adopt said best practices to improve the clinical and cost effectiveness of patient services.
o Works with the Network and Quality national leadership to develop and deploy best practice PCMH, ACO and value based purchasing efforts in the region.
o Participates with the VP, Medical Policy and Programs in the development, implementation and interpretation of medical/clinical policy for the designated business unit (including Medical Necessity Criteria, Clinical Practice Guidelines and New Technology Assessments).
o Ensures that the medical directors are applying the medical/clinical policies to their respective areas of oversight.
o Ensures effective deployment of medical and clinical resources and consistency across the service systems including ensuring that critical functions are developed and deployed as specific needs arise.
o Drives to resolution short term, cross functional issues adversely impacting clinical outcomes.
o Participates in clinical program development across the service spectrum and implementation and interpretation of clinical and medical policies and procedures.
o Participates in national and local Physician recruitment (including oversight of onboarding and training).
o Designs and implements national provider profile.
o Oversees all utilization management, care management, disease management and quality management activities.
o Continuously assesses and improves the quality of care provided to behavioral health recipients.
o Develops and implements the National and Local QM and UM plans.
o Manages all clients covered by a specific region (e.g., Northeast), as well as management of all levels of Medical Directors serving those geographic populations.
o Manages the work of local Medical Directors in providing cost-effective and quality care management services.
o Plans and schedules staff, ensuring full staff coverage for standard work week and after-hours coverage.
o Oversees cost of care of health plans under the direction of the VP, including reviewing data, interpreting data, and applying data for operational and cost of care interventions.
o Interfaces with clients within the region, and is expected to divide opportunities for interactions with health plans, state agencies and other stakeholders within the region.
o Participates in the RFP process for new business opportunities in the region.
Provides overall clinical construct and direction for RFP responses for the designated business unit region to ensure the clinical integrity of serving complex populations
General Job Information
VP, Medical Director - Physical Health
Clinical Services Group
United States of America
United States of America (Exempt)
Recruiting Start Date
Date Requisition Created
DO (Required), MD (Required)
License and Certifications - Required
DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician
License and Certifications - Preferred
Other Job Requirements
- Managed care experience as a provider and a manager of care.
- Utilization Review or Physician Advisor experience.
- Complex case management experience.
- Accreditation experience (NCQA, AAHCC/URAC).
- Graduate of an American or Canadian medical school accredited by the Accreditation Council for Medical Education (ACME) or equivalent training in a foreign medical school with successful completion of the ECFMG and FLEX examinations.
- Full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME).
- Minimum of three years involving substantial direct patient care during this period at multiple levels of care.
- Clinical experience pertinent to the patient population(s) being managed.
- Unrestricted current and valid license or certification to practice medicine in a state or territory of the United States.
- Ability and desire to lead through and effect appropriate changes.
- Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance and continuous quality improvement (CQI) processes.
- After Hours coverage may be required.