VP, Physician Review, Market Insights

This is a fully remote position, open to applicants in United States.

📋 Description

• Establish clinical strategy and lead the Utilization Management department.

• Supervise the collaboration of medical doctors and registered nurses in UM across both Medicaid and Medicare.

• Provide direction in risk management, grievance and appeals processes, clinical contracting, vendor relations, and UM dental evaluations.

• Ensure that the clinician’s perspective remains central to the decision-making processes of the organization.

• Utilize analytics to guide strategy development and enhance performance improvement.

• Champion the growth of clinical talent and establish a leadership pipeline.

⛳️ Requirements

• MD/DO qualification.

• Current Board Certification.

• At least 10 years of combined leadership and/or UM experience.

• A strong commitment to enhancing Star Ratings, ensuring review consistency, and improving health outcomes.

• Extensive knowledge of the medical, clinical, and behavioral sciences that form the basis of UM.

• Excellent interpersonal, leadership, and business skills.

• Demonstrated ability to achieve cross-functional results and advocate for clinical viewpoints.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Flexible work hours.

• Paid time off.

• Options for remote work.