• Medical Director, Post-Acute Care Utilization…

    MVP Health Care (Rochester, NY)


    At MVP Health Care, we’re on a mission to create a healthier future for everyone – which requires innovative thinking and continuous improvement. To achieve this, we’re looking for a **Medical Director, Post-Acute Care Utilization Management** to join #TeamMVP. If you have a passion for collaboration and clinical leadership, quality improvement and medical decision making this is the opportunity for you.

    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** .

    Qualifications you’ll bring:

    + Current unrestricted licensure (MD or DO) in any US state Eligible for licensure (MD or DO) in New York State and Vermont Board Certified in any ABMS-certified primary care or specialty practice

    + Minimum of 10 years in clinical practice with evidence of leadership

    + excellence. 3 years of experience in UM related to SNF, IRF, LTACH admissions, continued stay and discharges.

    + Strong organizational, communication, and writing skills for function in a highly matrixed environment are essential

    + The ability to communicate effectively with physicians in practice and facility staff is essential.

    + The ability to effectively use the computer is essential.

    + Ability to critically evaluate and research medical literature is essential

    + Knowledge of quality improvement including HEDIS, STAR, CAHPS measures is preferred.

    + Knowledge of and experience with NCQA requirements is desirable

    + Curiosity to foster innovation and pave the way for growth

    + Humility to play as a team

    + Commitment to being the difference for our customers in every interaction

    Your key responsibilities:

    + Adjudicate initial, reconsideration and appeal authorizations for Post-Acute Care requests additional involvement in adjudicating pharmacy, prospective, concurrent and retrospective prior authorization requests for all lines of business.

    + Integral involvement in building our Post-Acute Care UM team

    + Assisting and training other medical directors at MVP Healthcare in post-acute care UM This includes guiding them in the proper adjudication of initial admission reviews, continued stay requests, and handling first-level appeals.

    + Collaborate with Utilization Management, Case Management, Quality Department and other areas of the Health Management Department.

    + Perform Peer to Peer conversations per provider request

    + Other duties as assigned by leadership

    + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

    Where you’ll be:

    Hybrid in NYS

    \#CS

    Pay Transparency

    MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

     

    We do not request current or historical salary information from candidates.

    MVP's Inclusion Statement

    At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.

     

    MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.

     

    To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at [email protected] .

    Job Details

    Job Family** **Medical Management/Clinical

     

    Pay Type** **Salary

     

    Hiring Min Rate** **240,067 USD

     

    Hiring Max Rate** **270,000 USD