• Job Description

  Req#: 2635

  Medical Director, Clinical Review and Care Integrity

  625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA Req #2635

  Tuesday, June 3, 2025

  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, Clinical Review and Care Integrity 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:

  • M.D. or D.O. with current, unrestricted license to practice medicine in any US state. Eligible for licensure in New York State and Vermont

  • Board certification in a recognized specialty
  • Minimum of 5 years of clinical practice experience
  • Managed care, utilization management, or health plan operations experience preferred.
  • Experience working in a matrixed healthcare environment
  • Previous medical director or clinical leadership experience within a health plan preferred
  • Strong organizational, communication, and writing skills for function in a highly matrixed environment are essential
  • Ability to communicate effectively with physicians in practice and facility staff is essential.
  • Ability to effectively use the computer is essential.

  • Ability to critically evaluate and research medical literature is essential.
  • Strong understanding of medical necessity criteria (e.g., InterQual, MCG) and relevant regulatory/accreditation requirements (e.g., CMS, NCQA, DOH)
  • Knowledge of quality improvement including HEDIS, STAR, CAHPS measures is preferred.
  • Familiarity with quality improvement and population health strategies
  • 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:

  • Render timely first- and second-level clinical determinations based on evidence-based criteria and regulatory requirements.
  • Provide clinical support across Utilization Management, Case Management, Appeals, and other Health Management functions to improve care quality and outcomes across all business lines.
  • Support the design, implementation, and execution of Quality and Medical Operations initiatives within a highly matrixed organizational structure.
  • Collaborate with internal leadership to identify and implement programs aimed at enhancing care quality, optimizing service and medication utilization, improving adherence, advancing care management strategies, and managing healthcare costs.
  • Participate in MVP training, Medical Director meetings, and conference calls.
  • Provide after-hours and weekend transactional coverage on a rotating schedule.
  • Perform other duties as assigned
  • 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

  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] .
  

  Other details

  • Job Family Medical Management/Clinical
  • Pay Type Salary
  • Min Hiring Rate $240,067.00
  • Max Hiring Rate $270,000.00

  Apply Now

• About the company

  Health insurance plans, dental insurance plans, and medicare plans for individuals and employers in New York & Vermont from MVP Health Care.

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