VP - Medical Management

As the Vice President of Medical Management at CareCentrix, you will be responsible for leading the physician team in the medical oversight and strategic direction of the organization’s clinical programs. These programs include, but are not limited to, post-acute care, durable medical equipment (DME), home health, palliative care, and home infusion services. This leadership role plays a critical part in supporting internal operations while also serving as a key interface with external providers and clients.

This position requires a blend of internal and external responsibilities, encompassing physician management and oversight, support of internal clinical and nonclinical teams, and contributing to business objectives by engaging with and influencing external providers. Key responsibilities include physician oversight and management, conducting audits, ensuring the appropriate application of CMS guidelines and national accreditations (e.g. NCQA and URAC), and overseeing policies and workflows. Additionally, the role is highly integrated into product, network, operations, finance, and sales functions.

• Leads the Medical Director Team to operationalize CareCentrix clinical management programs
• Collaborates closely with Clinical Operation leadership, the nursing teams, and non-clinical support roles.
• Develops and revises CareCentrix clinical guidelines, criteria and other decision support tools, including evaluations and recommendations on new and emerging technologies, and industry standard treatment protocols.
• Conducts VIP elevated medical necessity reviews, peer-to-peer consultations, etc.
• Responsible for the operational performance of our Independent Review Organization vendors
• Represents the clinical organization at Quarterly Joint Operating Committee meetings held with clients.
• Collaborates with Health Plan leadership and network providers to drive improved product performance and patient outcomes.
• Utilizes the clinical metric dashboards to monitor and influence clinical metrics through improved operational processes.
• Collaborates with multiple CareCentrix departments including, but not limited to, product, data analytics, technology and sales.
• Provides recommendations and assists with development of CareCentrix pilot programs and clinical processes to improve efficiency and clinical outcomes.
• Responsible for the operational performance of CareCentrix’s Products including the post-acute program, home health, DME, sleep, home infusion therapy and palliative care.
• Maintains a data driven approach to continually improve product performance.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted medical license.
• Minimum of 10 years in clinical practice.
• At least 8 years of experience in managed care programs, ideally within the healthcare insurance industry.
• 8+ years of leadership experience, including team management and driving improvements in operational processes and clinical performance metrics.
• Exceptional written and verbal communication skills.

What we offer:

• Pay Range: $325000 – $350000 / year plus corporate bonus incentive.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Flexible Time Off, 401K Savings Plan with Employer Match, Paid Parental Leave, and more.
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.

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