Medical Director, Behavioral Health Children's Services

Mvp Health Plan Inc•Schenectady, NY

73d•Remote

About The Position

The medical director 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. Conducts 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. It is preferred the applicant is in NYS but not a must; location near one of MVPs administrative locations preferred (Schenectady, Rochester, Tarrytown). Performs other duties as assigned. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Requirements

Licensed to practice medicine in New York State.
Board Certified in child and adolescent psychiatry.
Minimum of five years of experience working with children in BH managed care settings or BH clinical settings (at least two years must be in a clinical setting).
Individuals must understand various levels of care within NYS addiction and mental health services including knowledge of NYS child serving systems.
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.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction

Nice To Haves

Previous experience as a medical director in a managed care/health plan is desirable.
Experience with critical review in clinical scenarios is desirable.
Knowledge of and experience with NCQA requirements and HEDIS reporting is desirable.
It is preferred the applicant is in NYS but not a must; location near one of MVPs administrative locations preferred (Schenectady, Rochester, Tarrytown).

Responsibilities

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.
Conducts 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.
Supports other key stakeholders such as sales and marketing, quality, operations, and others through matrixed leadership.
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.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.