Behavioral Health, Medical Director, HARP BH Adult Services
Status: Full-time, Exempt: Yes
Provides clinical expertise and timely first and second level clinical determinations based on MVP’s policies/procedures, state and federal guidelines, national accreditation standards, benefits interpretations, and other medical necessity criteria as necessary. May conduct pediatric reviews.
Lead’s MVP’s efforts to collaborate in person and virtually with behavioral health network providers and facilities around clinical determinations, policy interpretation, sharing of leading indicator and quality data.
Partners with other leaders and executives to represent behavioral health and integrated health programming to state, federal and other regulators as needed.
Identifies and implements initiatives in collaboration with other senior leaders to promote appropriate care quality, service utilization, medication utilization and adherence, care management, and cost control.
Through matrixed leadership supports other key stakeholders such as sales and marketing, quality, operations, and others.
Supports and communicates effectively with MVPs Quality Improvement, Pharmacy, Health Promotions, and Disease Management Programs.
Actively participates in MVP training and medical directors’ meetings and conference calls.
Provides coverage outside of normal business hours on a rotational basis. Must be a New York State resident; location near one of MVPs administrative locations preferred (Schenectady, Rochester, Tarrytown)
Performs other duties as assigned.
Licensed to practice medicine in New York State.
Board Certified in General Psychiatry
Certification in Addiction Medicine or in the subspecialty of Addiction Psychiatry strongly preferred
Minimum of 5 years post residency experience in a clinical or managed care setting is required, with at least 2 years are set in a clinical setting.
Previous experience as a medical director in a managed care/health plan is desirable.
Previous experience with pediatric population preferred.
• Experience with critical review in clinical scenarios is desirable.
• Knowledge of and experience with NCQA requirements and HEDIS reporting is desirable.
• Strong organizational, communication, and writing skills for function in a highly matrixed environment are essential
• Ability to communicate effectively with physicians in practice and facility staff is essential.
• Travel throughout MVP Health Care’s Service area is required.
• Ability to effectively use the computer is essential.
• Ability to critically evaluate and research the medical literature is essential.
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- Job Family Medical Management/Clinical
- Pay Type Salary
- Headquarters Office, Schenectady, New York, United States of America
- Rochester Office, Rochester, New York, United States of America
- Tarrytown Office, Tarrytown, New York, United States of America