Chief Medical Officer, Health Plans

Company: VNS Health
Location: New York
Posted on: June 1, 2025

Job Description:

OverviewProvides clinical expertise and guidance to the daily operations and administration of medical management for VNS Health Plans. Assists senior leadership in planning, directing, and coordinating all medical and related activities. Participates in implementing standards of medical service and advises senior leadership on medical and administrative questions and policies related to the VNS Health Plans population. Investigates and implements new medical policies based on clinical expertise, data analysis, and interpretation to improve clinical outcomes. Serves as a consultant for complex medical cases. Participates in QARR/HEDIS Quality Improvement Activities and utilization management of the population. Works under limited direction.What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days, and 9 company holidays
• Health insurance for you and your loved ones: Medical, Dental, Vision, Life Disability
• Employer-matched retirement savings
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancementWhat You Will Do
  • Oversee clinical components for utilization review and decision-making within VNS Health Plans
  • Establish medical policies, collaborate on care management strategies, and communicate with providers to ensure quality care
  • Review utilization, care management, and behavioral health data; identify trends; develop and implement improvement plans
  • Guide and consult with Utilization Management (UM) and Care Management (CM) staff on clinical issues, case management, and health assessments
  • Lead the Quality Improvement Program and advise leadership on medical service policies
  • Ensure compliance with federal, state, and local laws; work with Compliance and SIU on fraud, waste, and abuse issues
  • Collaborate with pharmacy services on PBM activities, prior authorization denials, and medication review education
  • Evaluate program and member service policies to enhance care delivery and satisfaction
  • Represent VNS Health Plans externally, promoting services and educating stakeholders
  • Engage with providers to understand barriers and discuss options for quality care
  • Design, develop, and assess disease management and health programs
  • Perform clinical reviews, peer-to-peer meetings, and complex case reviews
  • Participate in committees related to credentialing and utilization managementQualificationsLicenses and Certifications:
    • Licensed to practice medicine in New York State (required)
    • Multi-state licensure (preferred)
    • Board Certification in internal or family medicine (preferred)
    • Geriatric Care certification (preferred)
    • Valid driver's license or NYS Non-Driver ID (may be required)Education:
      • Medical Degree (required)Work Experience:
        • Minimum five years in clinical medicine, including three in managed care, with experience in evidence-based medical necessity and CMS guidance
        • Geriatric medicine experience (preferred)
        • Experience in a Medical Services Organization (preferred)
        • Strong knowledge of Medicare and Medicaid regulations
        • Excellent communication and leadership skills
        • Critical thinking and decision-making skills (preferred)Pay RangeUSD $243,000 - $324,000 per yearAbout UsVNS Health is a leading nonprofit home and community health care organization with over 130 years of experience. We are committed to helping people live, age, and heal in their own homes, connected to their families and communities. Our team of over 10,000 provides compassionate, expert care and 24/7 support to more than 43,000 individuals. Powered by advanced data analytics, we offer comprehensive health care services, solutions, and health plans to meet diverse community needs in New York and beyond.
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Keywords: VNS Health, Bristol , Chief Medical Officer, Health Plans, Executive , New York, Connecticut