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Medical Director, VNSNY Health Plans

Company: Visiting Nurse Service of New York
Location: Ridgefield Park
Posted on: January 15, 2022

Job Description:

OverviewDirects and oversees the administration of medical services and medical policy for all VNSNY health plan products. Establishes and implements policies and standards to ensure quality medical care is provided to members enrolled in any VNSNY health plans. Oversees medical utilization, quality management, grievances & appeals, and evaluates physician reimbursement. Participates in the network recruitment of hospitals and physicians and may assist in sales presentations to physicians. Works under limited directionResponsibilitiesDirects and oversees the medical operations for all VNSNY health plans. Established policies and procedures to ensure that high quality and cost effective Medicare services are offered to all Medicare enrollees and that long term care services are provided to all health plan members by assigned staff or through contracted relationships in home, community and facility-based settings within a capitated reimbursement rate.Ensures that ongoing medical management, utilization review, credentialing, grievances & appeals, and care coordination is approved, provided and managed by clinical staff.Manages the Medicare Quality Assurance Program and advises governing authority on the adoption/enforcement of polices concerning medical services. Chairs the Quality Improvement Committee, Utilization Management Subcommittee, the Credentialing Subcommittee and the Physician Advisory Subcommittee.Identifies medical trends and needs that impact VNSNY health plans and develops plans to meet these needs. Monitors and evaluates trends, issues, and needs for program services and formulates strategies to address those needs.Manages and evaluates staff in delivery and coordination of comprehensive home and community-based long term care services in accordance with standards of medical practice.Identifies areas where there are medical cost outliers and implements strategies for medical cost management, as appropriate.Monitors program expenditures and use of medical services included in the Medicare Premium or capitated reimbursement.Acts as a representative of the VNSNY Health Plans and an advocate for the community through liaison, lecturing and promotional activities. Presents to Board of Directors as needed.Ensures compliance with relevant and applicable federal, state and local laws and regulations.Performs all duties inherent in a senior managerial role. Approves staff training, hiring, promotions, terminations and salary actions, prepares and ensures adherence to the department budget.Performs related duties as assigned or requested.QualificationsLicensure: Licensed to practice medicine in New York State required. Board Certification in primary care or in one of the following specialties: in family practice, internal medicine, cardiology required. Certification in Geriatric Care preferred. Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.Experience: Minimum five years experience in clinical medicine, including the care of geriatric patients, required. Minimum three years of medical management experience required. Administrative and/or management experience required. Managed care experience preferred.

Keywords: Visiting Nurse Service of New York, Clifton , Medical Director, VNSNY Health Plans, Executive , Ridgefield Park, New Jersey

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