Medical Director, Clinical Review and Care Integrity
About The Position
Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.
Requirements
- MD or DO with current, unrestricted licensure in any U.S. state. Eligible for licensure in New York and Vermont.
- Board certification in an ABMS-recognized primary care or specialty discipline.
- Minimum 10 years of clinical practice with demonstrated leadership experience.
- Strong organizational, communication, and writing skills for functioning in a highly matrixed environment.
- Ability to communicate effectively with physicians, practice staff, and facility personnel.
- Proficiency in computer systems and electronic documentation.
- Ability to critically evaluate and research medical literature.
Nice To Haves
- At least 3 years in a managed care environment preferred.
- Experience with post-acute care initial and appeal determinations is preferred
- Knowledge of quality improvement programs (HEDIS, STAR, CAHPS measures).
- Familiarity with NCQA requirements
Responsibilities
- Render first- and second-level clinical determinations based on medical necessity criteria, MVP policies, and regulatory guidelines.
- Collaborate with Utilization Management, Case Management, and Appeals teams to enhance care quality and service utilization.
- Support implementation of quality improvement initiatives in a matrixed environment.
- Identify and execute strategies to promote medication adherence, care management, and cost containment.
- Participate in Medical Director training sessions, meetings, and conference calls.
- Provide transactional coverage outside normal business hours on a rotational basis, including weekends.
- Perform other duties as assigned.
Benefits
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Ph.D. or professional degree
Number of Employees
501-1,000 employees
