Works collaboratively with the Chief Medical Officer (CMO), senior leadership of designated business unit nationally and regionally to achieve overall company goals of growth, financial performance including cost of care and clinical quality improvement. Responsible for leading and managing the local physicians providing Utilization Management reviews and leading rounds. Provides strategic oversight of national comprehensive medical policies and programs to include contributions to the development, implementation and evaluation of the clinical and cost effectiveness of medical services. Must also collaborate with Magellan Rx colleagues to this end as well. Serves as the primary medical representative on behalf of the designated business unit both internally and externally when the CMO is not available. Manages physicians who manage medical relationships with state government agencies, provider network organizations and other physical and behavioral health entities to facilitate the delivery of appropriate quality care. In tight partnership with the local physicians, oversees the national clinical quality program for designated business unit region, utilization management, care management and disease management processes and outcomes and provides oversight of the overall clinical program and strategic initiatives for enterprise consistency and integrity.Works closely with the Chief Medical Officer, members of the national corporate clinical executive team, and most tightly with the designated business unit leadership team to create and implement national medical and clinical policy and programs for the designated business unit region.
Interfaces with National and State medical leadership, both in standing meetings and as needed, to discuss emerging issues, improvement in metrics, and strategic plans.
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.
Provides strategic direction and implementation assistance for Disease and Care Management programs nationally.
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.
Works with the Network and Quality national leadership to develop and deploy best practice PCMH, ACO and value based purchasing efforts in the region.
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).
Ensures that the medical directors are applying the medical/clinical policies to their respective areas of oversight.
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.
Drives to resolution short term, cross functional issues adversely impacting clinical outcomes.
Participates in clinical program development across the service spectrum and implementation and interpretation of clinical and medical policies and procedures.
Participates in national and local Physician recruitment (including oversight of onboarding and training).
Designs and implements national provider profile.
Oversees all utilization management, care management, disease management and quality management activities.
Continuously assesses and improves the quality of care provided to behavioral health recipients.
Develops and implements the National and Local QM and UM plans.
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.
Manages the work of local Medical Directors in providing cost-effective and quality care management services.
Plans and schedules staff, ensuring full staff coverage for standard work week and after-hours coverage.
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.
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.
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 DirectorGrade
Clinical Services GroupCountry
United States of AmericaFLSA Status
United States of America (Exempt)Recruiting Start Date
9/9/2019Date 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) - PhysicianLicense and Certifications - Preferred
Other Job Requirements
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.
Unrestricted current and valid license or certification to practice medicine in a state or territory of the United States.
Full training in a residency program in the United States or Canada that is approved by the ACGME.
Post-residency experience of at least 5 years involving substantial direct patient care during this period at multiple levels of care.
Clinical experience pertinent to the patient population(s) being managed, specifically complex populations, Medicaid and/or Medicare.
Utilization Review and Care Management experience required.
Managed care experience required, as provider and / or manager of care.
Clinical program development and strategic planning preferred. Accreditation experience (NCQA, AAHCC/URAC) preferred.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.