**Join Us in Shaping the Future of Health Care** At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. **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** . You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. The Medical Director provides clinical expertise and leadership in delivering timely first- and second-level clinical determinations in accordance with MVP Health Care’s policies, state and federal regulations, national accreditation standards, and benefit interpretations. This role supports collaboration across Utilization Management, Case Management, Appeals, and other Health Management divisions to improve clinical outcomes and operational efficiency. The Medical Director also contributes to quality initiatives, cost control strategies, and consistency in medical decision-making across all business lines. **Key Responsibilities** + Render first- and second-level clinical determinations based on medical necessity criteria, MVP policies, and regulatory guidelines. + Collaborate with Utilization Management, Case Management, and Appeals teams to enhance care quality and service utilization. + Support implementation of quality improvement initiatives in a matrixed environment. + Identify and execute strategies to promote medication adherence, care management, and cost containment. + Participate in Medical Director training sessions, meetings, and conference calls. + Provide transactional coverage outside normal business hours on a rotational basis, including weekends. + Perform other duties as assigned. **Position Qualifications** **Education:** + MD or DO with current, unrestricted licensure in any U.S. state. + Eligible for licensure in New York and Vermont. + Board certification in an ABMS-recognized primary care or specialty discipline. **Experience:** + Minimum 10 years of clinical practice with demonstrated leadership experience. + At least 3 years in a managed care environment preferred. + Experience with post-acute care initial and appeal determinations is preferred **Required Skills:** + Strong organizational, communication, and writing skills for functioning in a highly matrixed environment. + Ability to communicate effectively with physicians, practice staff, and facility personnel. + Proficiency in computer systems and electronic documentation. + Ability to critically evaluate and research medical literature **Preferred Skills:** + Knowledge of quality improvement programs (HEDIS, STAR, CAHPS measures). + Familiarity with NCQA requirements **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. $200,056.00-$266,074.00 **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 hr@mvphealthcare.com .