Medical Director, Behavioral Health Childrens Services

MVP Health Care • Schenectady, NY

102d

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. Leads 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 MVP's 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 MVP's 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).
• Previous experience as a medical director in a managed care/health plan is desirable.
• Individuals must understand various levels of care within NYS addiction and mental health services including knowledge of NYS child serving systems.
• 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.
• Ability to effectively use the computer is essential.
• Ability to critically evaluate and research the medical literature is essential.

Nice To Haves

• 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.

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.
• Conducts pediatric reviews.
• Leads 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 MVP's 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.

What This Job Offers

• Industry: Insurance Carriers and Related Activities