VP, Physician Review and Market Insights (Healthcare)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services for Medicare, Medicaid, families, individuals, military personnel, and communities.

What you will do

• Set clinical strategy and lead the Utilization Management organization across Medicaid and Medicare.
• Oversee outpatient and inpatient physicians, registered nurses, and non-clinical support functions.
• Lead risk management, grievances and appeals, clinical contracting, vendor management, and dental review.
• Use analytics to improve performance, operational efficiency, review consistency, Star Ratings, and health outcomes.
• Develop clinical talent and the leadership pipeline while ensuring clinician perspectives inform organizational decisions.
• Manage a significant functional organization with accountability for human capital and organizational performance.

Requirements

• MD or DO degree.
• Current board certification.
• At least 10 years of combined leadership and/or Utilization Management experience.
• Deep knowledge of medical, clinical, and behavioral science supporting Utilization Management.
• Strong interpersonal, leadership, and business acumen, with the ability to drive cross-functional results.
• Dedicated home workspace and internet service with at least 25 Mbps download and 10 Mbps upload speeds.

Culture & Benefits

• Remote work arrangement with occasional office travel for training or meetings.
• Focus on whole-person health and evidence-based clinical practices.
• 40 scheduled hours per week.
• Work must protect member PHI and HIPAA information through a dedicated, interruption-free workspace.