HARP Medical Director
Company: Metroplus Health Plan
Location: Newark
Posted on: June 25, 2022
|
|
Job Description:
Empower. Unite. Care.MetroPlusHealth is committed to empowering
New Yorkers by uniting communities through care. We believe that
Health care is a right, not a privilege. If you have compassion and
a collaborative spirit, work with us. You can come to work being
proud of what you do every day.About NYC Health +
HospitalsMetroPlusHealth provides the highest quality healthcare
services to residents of Bronx, Brooklyn, Manhattan, Queens and
Staten Island through a comprehensive list of products, including,
but not limited to, New York State Medicaid Managed Care, Medicare,
Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold,
Essential Plan, etc. As a wholly-owned subsidiary of NYC Health +
Hospitals, the largest public health system in the United States,
MetroPlusHealth' network includes over 27,000 primary care
providers, specialists and participating clinics. For more than 30
years, MetroPlusHealth has been committed to building strong
relationships with its members and providers to enable New Yorkers
to live their healthiest life. Position Overview Responsible and
accountable to the Chief Medical Officer, with dotted reporting to
the Head of Behavioral Health, for helping to manage health plan
behavioral health quality and utilization and assuring appropriate
health care delivery. The HARP Medical Director serves in policy,
operational and strategic capacities. The HARP Medical Director has
over all accountability for behavioral health services for HARP
plan enrollees. This is a broad function that includes day to day
operations, data and reporting design and high-level strategy,
planning and policy involvement.Job DescriptionSupport the
maintenance of clinical protocols and policies to enhance the
quality of medical necessity decision-making, incorporating input
from the clinical review team, operations, and other medical
operations leads such as the OMH / OASAS State Medical Directors
forums. Support the use of integrated care models such as
collaborative care model for treating conditions in primary care.
Conduct analyses to identify trends and patterns suggestive or
indicative of:Inappropriate, unreasonable, medically unnecessary
care; inappropriate transfers; and Insufficient, poor documentation
or patterns of failing to provide medical records.Chair the Case
Management / Utilization Management HARP quarterly
Subcommittees.Supervise retrospective review of claims to identify
practice patterns that could be improved to reduce inappropriate
utilization of services and improve care.Conduct timely
peer-to-peer discussions with treating providers to clarify
clinical information and outcome decisions, including feedback on
alternate treatment based on medical necessity criteria.Promote
medical necessity determinations that consider level of need as
well as environmental factors, available resources, and
psychosocial rehabilitation standards. Develop a working
familiarity with applicable SUD regulatory standards based on the
OASAS LOCADTR tool. Understanding of specialized expertise for
assessment, treatment and management of special population,
including older adults, transition age youth (TAY), individuals
with co-occurring disorders, individuals experiencing first episode
of psychosis (FEP) individuals with SMI and criminal justice or
assisted outpatient treatment (AOT) involvement and individuals
with SMI and /or functionally limited SUDs.Oversee the development
of evidence based clinical best practices, policies, and
practices.Participate as a member of Interdisciplinary Care Teams
(ICT) that ensures an integrated model of care approach for the
designated population(s); work with other medical representatives
of ICTs to ensure a consistent and high value approach to team
processes.Sole authority and responsibility for assuring that
clinical adverse determinations are based on medical necessity.Work
collegially with the Head of Behavioral Health to identify trends,
problems, and opportunities, including conduct root cause
analysis.Shares accountability with the Head of Behavioral Health
in meeting NCQA requirements for UM CM and operations.Work closely
with the corporate medical policy team for clinical input and
formulation of BH policies and protocols.Perform other duties as
needed and assigned by the Chief Medical Officer/Head of Behavioral
Health.Minimum QualificationsBoard Certified Adult Psychiatrist
with active New York license or certification to practice medicine
without restriction required (MD or DO required)Minimum of 5 years
of experience working in BH managed care setting and/or BH clinical
setting overseeing care management activitiesAppropriate training
and expertise in general psychiatry and or addiction disorders
requiredExperience with governmental programs including Medicaid,
Medicare, Long term care; additional experience in commercial/
MSO/ASO is a plusAdministrative experience on a hospital committee,
in a medical group or for an insurer preferredKnowledge of clinical
practice of medicine, health care delivery systems, utilization
methods and treatment Protocols requiredKnowledge and understanding
of managed care principles, industry evolution, physician
reimbursement, and human resource management requiredLicensure
and/or Certification RequiredCurrent unrestricted license to
practice medicine in the State of New York.Professional
CompetenciesIntegrity and TrustCustomer FocusFunctional/Technical
skillsWritten/Oral Communication
Keywords: Metroplus Health Plan, Newark , HARP Medical Director, Executive , Newark, New Jersey
Click
here to apply!
|