Medical Direction, Medical Director, HARP BH Adult Services
Status: Full-time, Exempt
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.
Actively work in a cross functional team to further design and implement MVP’s Integrated Health Strategy. Through matrixed leadership, support behavioral health and integrated health needs for other key stakeholders such as sales and marketing, quality, operations, credentialing, provider relations, 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.
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
Practice experience in a managed care environment is preferred but not required.
Minimum of 5 years post residency experience in a clinical or managed care setting is required, with at least 2 years in a clinical setting.
Previous experience as a medical director in a managed care/health plan is desirable but not required.
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/psychologists/mental health professionals 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 conduct data interpretation and analysis of member populations; proficient in basic functions of Excel.
• Ability to critically evaluate and research the medical literature is essential.
Must be a New York State resident (non-NYS residents may be considered if familiar with NYS practice standards in behavioral health); location near one of MVPs administrative locations preferred (Schenectady, Rochester, Tarrytown). Full-time preferred but part-time considered for right candidate.
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- Job Family Medical Management/Clinical
- Pay Type Salary
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America
- Rochester Office, 220 Alexander Street, Rochester, New York, United States of America
- Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America