Vice President of Medical Management

A company is looking for a Vice President Physician Medical Management.

Key Responsibilities

Provide physician leadership in developing medical management protocols and ensure compliance with evidence-based criteria

Oversee utilization management processes and ensure alignment with case management and care coordination strategies

Collaborate with stakeholders to analyze clinical and financial data, identifying trends to improve medical management effectiveness

Required Qualifications and Education

Minimum of 7 years of direct experience in utilization review, case management, and physician leadership within managed care or health plan environments

At least 10 years of progressive leadership experience in Medical Management, including roles as Medical Director or senior physician executive

Strong business acumen and operational mindset with a focus on clinical quality and cost efficiency

Experience with Managed Medicaid programs is strongly preferred

Deep understanding of regulatory standards (NCQA, CMS, state-specific requirements)