Vice President of Medical Directors – Health Plan

Job Title:
Vice President of Medical Directors – Health Plan

Salary Range: $360,000–$380,000 per year

Location:
New York City, NY
Hybrid:
Approximately 1 day per week onsite
Employment Type:
Full-Time, Direct Hire

RCM Healthcare Services is seeking an experienced Vice President of Medical Directors for a direct-hire leadership opportunity with a major health plan in New York City. Reporting to the Chief Medical Officer, this physician executive will provide leadership across medical management functions, with a particular focus on Utilization Management, health informatics, medical quality, regulatory compliance, and appropriate healthcare delivery
.

The role combines clinical and operational oversight with data strategy, policy development, regulatory involvement, and strategic planning across multiple lines of business and pharmacy. At RCM Healthcare Services, we’re passionate about connecting talented professionals with the right opportunities — join our network and be supported every step of the way.

• Full-time leadership position
• Hybrid work arrangement
• Approximately 1 day per week onsite in New York City

• Provide physician leadership across medical management functions, with a primary focus on Utilization Management (UM).
• Review complex cases, determine medical necessity, and consult with physicians regarding length of stay, level of care, and reimbursement documentation.
• Support UM staff and nurse Care Managers with concurrent review and preauthorization referrals, ensuring members receive appropriate services consistent with benefits, regulatory requirements, and established clinical criteria.
• Provide clinical expertise for member and provider appeals and collaborate with senior clinical leadership responsible for day-to-day UM operations.
• Help develop and advance the organization’s health informatics and data capabilities
  , using data and reporting to support clinical and operational decision-making.
• Participate in clinical policy review, new technology assessment, and implementation of policy and procedural changes resulting from state and federal regulatory requirements.
• Contribute to strategic planning for existing and expanding health plan business.
• Represent the organization at regulatory and industry meetings, including meetings involving New York State and New York City health agencies and managed care organizations.
• Partner closely with the Chief Medical Officer and other executive leaders on medical management strategy and organizational priorities.

• Doctor of Medicine (
  MD
  ) or Doctor of Osteopathic Medicine (
  DO
  ) degree from an accredited and approved medical school.
• Minimum of 3 years of clinical experience post-residency
  .
• Minimum of 5 years of experience in a managed care/health plan setting
  .
• At least 3 years of experience specifically overseeing Utilization Management
  .
• Proven experience with health informatics and/or healthcare data analytics
  .
• Demonstrated knowledge of healthcare regulatory compliance.
• Experience with New York State regulations and compliance strongly preferred
  .

• Valid New York State medical license and current registration required.
• Board Certification required.

• Strong physician executive leadership skills with demonstrated experience in a managed care environment.
• Extensive knowledge of Utilization Management, medical necessity, clinical criteria, and regulatory requirements
  .
• Ability to leverage healthcare data and informatics to support clinical and operational decision-making.
• Excellent written, verbal, interpersonal, and executive-level communication skills.

RCM Healthcare Services works with professionals across schools, healthcare,…