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Vice President - Medical Director

Job Category: Executive

Location: Field Office, NY, United States

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Job Description


The Medical Director responsible for providing clinical leadership to support the Healthfirst Chief Clinical Officer (aka Chief Medical Officer) in the administration of the Medical Cost Management Programs; Clinical Informatics Initiatives and Quality Improvement activities; for all products; Medicaid, Medicare Advantage, Managed Long Term Care and Commercial.

  • Leads using data from clinical and financial informatics programs and other sources to strategize and plan tactics for the management of medical services across products with a focus on improving outcomes for members and obtain medical cost goals using available resources
  • Leads the clinical arm of the Healthfirst Medical Cost Management Program (a cross departmental effort lead by clinical, financial, operational and network (DSE) leaders that maintains access to care by our members and promotes desired cost outcomes for that care
  • Leads the clinical arm of the SIU and FWA Programs at HF acting as a peer review leader and contributing decision maker in any SIU/FWA formal actions based on policy and regulations
  • Participates in enterprise wide leadership activities at the VP level including strategic and tactical planning
  • Works with partner hospitals and other contracted providers to support the and build provider relationships with a focus on those in Value-based arrangements shared risk business model of Healthfirst
  • Participates in and/or leads various committees and work groups as assigned to create or update policies and related procedures for utilization management, care management, credentialing, SIU, quality improvement and other programs under the office of the CMO

Regulatory or Compliance activities:

  • Participates and or leads as needed in the regulatory, professional and community activities to provide input and become knowledgeable regarding regulatory, professional and community standards and issues 

Minimum Qualifications:

  • Doctorate Degree in Medicine or Osteopathy
  • Board Certified (primary care or internal medicine preferred)
  • Current New York State medical license
  • Experience in Clinical practice
  • Clinical Informatics experience: 2-4 years’ experience preferred in the use of data to drive various medical cost and/or outcomes of care initiatives and/or Utilization Management experience; 2-4 years’ experience preferred and additional medical cost management experience preferred
  • Some mix of experience with medical administrative programs such as peer review, appeal review, grievance review, credentialing, and/or quality of care.

Required Qualifications: 

  • Experience with government programs including Medicaid, Medicare and Long Term Care managed care operations; additional experience in Commercial/ MSO/ASO is a plus
  • Participation in Clinical Peer Review, Quality Improvement, Quality Review or other clinical leadership position
  • Experience in public speaking or engagement with practicing physicians and other health care providers
  • Experience in health system or managed care organization’s business operations such as directly or indirectly managing credentialing, peer review or other clinically focused administrative department
  • Participates as needed in the regulatory, professional and community activities to provide input and become knowledgeable regarding regulatory, professional and community standards and issues 

License or Certification: MD or DO

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

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