Senior Medical Director
2 weeks ago
Position Overview
Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical quality, utilization, and assuring appropriate health care delivery, the Senior Medical Director serves in a policy, operational and strategic capacity. The Senior Medical Director overall purpose is to work across medical management functions, with a focus on Utilization Management and Business Intelligence, and across all lines of business and pharmacy. This is a broad function that includes day-to-day operations, data and reporting design, high-level strategy, planning, and policy involvement.
Job Description
- Reviews cases, determines medical necessity, and consults with physicians to review length of stay and reimbursement documentation.
- Supports Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals and ensures that members receive appropriate services consistent with their benefits, regulatory requirements, and established clinical criteria.
- Works with the VP of Clinical Services, who oversees day-to-day UM operations.
- Provides clinical support for member and provider appeals.
- Builds a health informatics function and ensures decisions are made according to data insights.
- Assists in new technology assessment and clinical policy review as required.
- Responsible for implementation of ongoing changes in policy and procedures from state and government entities.
- Participates in the development of strategic planning for existing and expanding business.
- Represents the health plan at regulatory meetings held by the New York State Department of Health, the New York City Department of Health and Mental Hygiene, and managed care trade organizational meetings as necessary.
- The VP of Medical Directors will be required to come to MetroPlusHealth HQ once a week (preferably on Thursdays)
- Performs other duties as needed and assigned by the Chief Medical Officer
Minimum Qualifications
- Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine.
- A minimum of three years' clinical experience post-residency
- A minimum of five years' experience in a managed care setting with at least 3 years specifically overseeing Utilization Management.
- Proven experience with heath informatics/data sciences and regulatory compliance
- Experience with NYS regulations and compliance is strongly preferred.
Licensure and/or Certification Required
- Valid and current license to practice medicine in the state of New York.
- Board Certification
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
#LI-Hybrid
-
Senior Director of Medical Directors
2 weeks ago
New York, United States NYC Health Hospitals Full timeMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned...
-
New York, United States Pfizer Full timeReporting to the VP, Global Gastroenterology Medical Lead, the Senior Director, Gastroenterology (GI) and Biosimilars is an integral member of the Specialty Care GI Global Medical team. The GI and Biosimilaers Senior Medical Director will serve as an Medical Director, Director, Senior, Medical, Global, Patient Access, Healthcare
-
Senior Medical Director
2 days ago
New York, United States Planet Pharma Full timeLocation: New York, NY. *Onsite 5 days per week. The office is located on Manhattan’s west side. This is an in-person position.Salary: $350K+Equity/BonusDirector of MedicalSeeking a seasoned Medical Director specialized in pharmacovigilance/drug safety and clinical development. A NYC-based growth-stage biopharmaceutical company in with an innovative...
-
Senior Medical Director
2 days ago
New York, United States Planet Pharma Full timeLocation: New York, NY. *Onsite 5 days per week. The office is located on Manhattan’s west side. This is an in-person position.Salary: $350K+Equity/BonusDirector of MedicalSeeking a seasoned Medical Director specialized in pharmacovigilance/drug safety and clinical development. A NYC-based growth-stage biopharmaceutical company in with an innovative...
-
Senior Medical Director
2 days ago
New York, United States Planet Pharma Full timeLocation: New York, NY. *Onsite 5 days per week. The office is located on Manhattan’s west side. This is an in-person position.Salary: $350K+Equity/BonusDirector of MedicalSeeking a seasoned Medical Director specialized in pharmacovigilance/drug safety and clinical development. A NYC-based growth-stage biopharmaceutical company in with an innovative...
-
Senior Medical Director
5 days ago
New York, United States Planet Pharma Full timeLocation: New York, NY. *Onsite 5 days per week. The office is located on Manhattan’s west side. This is an in-person position.Salary: $350K+Equity/BonusDirector of MedicalA NYC-based growth-stage biopharmaceutical company in with an innovative portfolio of novel, widely applicable therapeutic drug candidates, is seeking a Medical Director. The Director of...
-
Senior Medical Director
4 days ago
New York, United States Planet Pharma Full timeLocation: New York, NY. *Onsite 5 days per week. The office is located on Manhattan’s west side. This is an in-person position.Salary: $350K+Equity/BonusDirector of MedicalA NYC-based growth-stage biopharmaceutical company in with an innovative portfolio of novel, widely applicable therapeutic drug candidates, is seeking a Medical Director. The Director of...
-
New York, New York, United States NYU Langone Medical Center Full timeThe Laura and Isaac Perlmutter Cancer Center at NYU Langone Health is seeking applications from qualified individuals for the position of Division Director, Hematology and Medical Oncology, Perlmutter Cancer Center. The successful applicant should have substantial experience in in leadership and be able to oversee the entire division in both hematology and...
-
Senior Director of Major Gifts
4 days ago
New York, United States BridgePoint Associates Full timeSenior Director of Major GiftsHighly Regarded Medical School and HospitalNew York City Area (Hybrid)Salary: $150,000 to $200,000 per year, with potential flexibility based on experience Terrific Senior Director of Major Gifts position with a highly regarded medical school and hospital in New York City. The Senior Director of Major Gifts will be a strategic...
-
Senior Director of Major Gifts
3 weeks ago
New York, United States BridgePoint Associates Full timeJob DescriptionJob DescriptionSenior Director of Major GiftsHighly Regarded Medical School and HospitalNew York City Area (Hybrid)Salary: $150,000 to $200,000 per year, with potential flexibility based on experienceTerrific Senior Director of Major Gifts position with a highly regarded medical school and hospital in New York City. The Senior Director of...
-
Senior Director of Technology
1 month ago
New York, United States Bernard Nickels & Associates Full timeSenior Director, IT OperationsPOSITION OVERVIEW Reporting to the CIO, the Senior Director, IT Operations is responsible for ensuring the various segments of the IT department are providing the required tech support to client’s business teams in a manner that considers use of efficient processes, optimal deployment of IT staff and external consultants,...
-
Senior Director of Technology
3 weeks ago
New York, United States Bernard Nickels & Associates Full timeSenior Director, IT OperationsPOSITION OVERVIEW Reporting to the CIO, the Senior Director, IT Operations is responsible for ensuring the various segments of the IT department are providing the required tech support to client’s business teams in a manner that considers use of efficient processes, optimal deployment of IT staff and external consultants,...
-
Senior Director of Technology
3 weeks ago
New York, United States Bernard Nickels & Associates Full timeSenior Director, IT Operations POSITION OVERVIEW Reporting to the CIO, the Senior Director, IT Operations is responsible for ensuring the various segments of the IT department are providing the required tech support to clients business teams in a manner that considers use of efficient processes, optimal deployment of IT staff and external consultants, meets...
-
Director of Nursing
4 weeks ago
New York, United States Atria Senior Living Full timeThe Director of Nursing/Resident Services Director (RN) at Atria Riverdale will take total ownership of the Care Department. The Director will:Supervise, develop, and schedule the resident services staff according to Atria’s policies, procedures and standards.Establish and maintain a medication system which adheres to state, federal and company laws,...
-
Director of Nursing
4 weeks ago
New York, United States Atria Senior Living Full timeThe Director of Nursing/Resident Services Director (RN) at Atria Riverdale will take total ownership of the Care Department. The Director will:Supervise, develop, and schedule the resident services staff according to Atria’s policies, procedures and standards.Establish and maintain a medication system which adheres to state, federal and company laws,...
-
Director of Nursing
3 weeks ago
New York, United States Atria Senior Living Full timeThe Director of Nursing/Resident Services Director (RN) at Atria Riverdale will take total ownership of the Care Department. The Director will: Supervise, develop, and schedule the resident services staff according to Atrias policies, procedures and standards. Establish and maintain a medication system which adheres to state, federal and company laws,...
-
Float-Senior Director of Nursing
1 month ago
Edison, New Jersey, United States Sunrise Senior Living Full time: Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 6th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of. COMMUNITY NAME: Middlesex Country Metro Area Job ID: (phone number removed) JOB OVERVIEW: "Sunrise is the best...
-
Senior Director, Product Marketing
1 day ago
New York, United States Peloton Full timePeloton is looking for a Senior Director of Product Marketing to influence the product pipeline and contribute to the go-to-market plan for our unique hardware, software and app products. The Senior Director will be responsible for leading a team foc Director, Marketing, Product, Senior, Manufacturing, Technology
-
Medical Director
2 weeks ago
New York, New York, United States Atlas Search Full timeOur client is a leading healthcare provider dedicated to delivering exceptional pediatric care to the community. They are seeking a highly skilled and motivated Medical Director with a background in Pediatrics to lead their pediatric department and ensure the highest standards of patient care, medical excellence, and staff development.This Medical Director...
-
Pediatric Medical Director Upstate NY
1 month ago
New York, New York, United States Continuum Medical Staffing Full timePEDIATRIC MEDICAL DIRECTOR UPSTATE NYPediatric Director Position/ & Outpatient PracticeSeeking a Be/Bc Pediatric Physician with Experience who is interested in a Pediatric Medical Director Position.This will be a Hospital Employed Position with a Excellent salary offered in the range of $250k to $300k plus a Sign on Bonus, Incentives, Benefits and...