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SalaryOver 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!
Status: Part Time- Exempt
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.
POSITION QUALIFICATIONS
Minimum Education:
Licensed to practice medicine in New York State.
Board Certified in child and adolescent psychiatry.
Minimum Experience:
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.
Required Skills:
- Individuals must have an understanding of 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.
- 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.
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
In addition, we offer a comprehensive benefits package that includes:
- Considerable paid time away from work including PTO (Paid Time Off), sick time, service time off, paid holidays, and floating holidays, allowing you to take time off when it suits you best.
- Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement.
- Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family.
- Life insurance and disability coverage to ensure financial security for you and your dependents.
- An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected.
- Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning.
- A best-in-class employee Well-Being program to support all dimensions of your health and wellness.
More detailed information about total compensation and benefits will be provided during the hiring process.
Please apply and learn more – including how you may become a proud member of our team.
