The VP, Medical Director provides clinical leadership and administrative guidance to all departments within QHCM, directs performance and quality improvement initiatives, develops and maintains operational policies for the department. Specifically, this position will implement and monitor the Quality Management program and assists in the development of policies and procedures. Provides leadership to the Informatics Unit and provides clinical liaison to IT department. The VP, Medical Director will have some involvement with Utilization Management-related activities (such as prior authorization, concurrent review, appeals, and DRG validation reviews). The VP identifies, communicates and holds staff accountable for performance expectations; monitors/appraises the job results/performance and promotes a positive, team-oriented work environment.
• 60% Quality Management: Supervises the Director of Quality Management. Provides clinical leadership to the QM area and the Plan’s Clinical Advisory Committee. Oversees quality improvement initiatives internally and externally.
• 25% Informatics and Analysis of Components of Medical Care: Ability to develop reports describing specific medical services and then apply the results of the analysis to current processes (e.g. readmissions, reducing admissions related to Ambulatory Sensitive Conditions).
• 15% Appeals and Grievances, DRG Validation Reviews: Apply and utilize medical policy when reviewing decisions on appeals & grievances (internal and external), and DRG validation reviews.
• Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes.
• Analytical Problem Resolution: Able to use systematic techniques to define problems, options, and solutions; evaluate alternative solutions; solve technical problems using logic.
• Deal with Ambiguity: Able to maintain composure and handle frequent job changes or unexpected disruptions; work with conflicting, delayed, or unclear information; remain effective when faced with change and uncertainty.
• Decision Making: Able to make objective decisions when dealing with emotional or controversial topics; identify and choose between multiple options; understand consequences of potential decisions.
• Integrity: Able to demonstrate sound business ethics; show consistency of words and actions; protect confidential information; practice what he or she preaches; do what is right even when no one is watching.
• Leadership: Able to motivate others to take personal responsibility; mobilize people to face, define, and solve problems; develop capacity of others to adapt to change; lead past status quo to achieve new levels of excellence or change.
• 5+ years of related experience
• Doctor of Medicine required
• MPH or MBA preferred
• Prior clinical practice experience required
• Managed Care Experience required
• Must be a board certified physician licensed to practice in New York