Medical Director

23 hours ago


New York, New York, United States MetroPlusHealth Full time

Job Title: Medical Director

Job Summary:

MetroPlusHealth is seeking a highly skilled Medical Director to join our team. As a key member of our leadership team, the Medical Director will play a critical role in ensuring appropriate healthcare utilization management and providing medical expertise to support our mission.

Key Responsibilities:

  • Develop and implement utilization management strategies to ensure high-quality, cost-effective care for our members.
  • Collaborate with our clinical team to develop and maintain clinical policies and guidelines.
  • Conduct peer-to-peer discussions with physicians and other healthcare professionals to educate them on current policies and medical management issues.
  • Supervise retrospective reviews of claims to identify areas for improvement and reduce costs.
  • Conduct analyses to identify trends and patterns suggestive of inappropriate or excessive use of services or equipment.
  • Participate in department committees and contribute to the development of clinical policies and guidelines.

Requirements:

  • Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine.
  • A minimum of three years' clinical experience.
  • A minimum of two years' experience in a managed care setting, particularly in utilization management.
  • Valid and current license to practice medicine in the state of New York.
  • Board Eligible/Certification.

Professional Competencies:

  • Integrity and Trust.
  • Customer Focus.
  • Functional/Technical Skills.
  • Written/Oral Communications.

About MetroPlusHealth:

MetroPlusHealth is a not-for-profit health plan dedicated to providing high-quality, affordable healthcare to our members. We are committed to improving the health and well-being of our communities and are seeking a talented Medical Director to join our team.



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