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PURPOSE OF THE POSITION: The Behavioral Health Medical Director oversees the practices and corresponding documentation of all mental health and chemical dependence psychiatric services provided to children, adolescents and adults in accordance with governmental regulations. Reporting to the Chief Medical Officer, helps manage health plan behavioral health quality and costs while assuring appropriate health care delivery.
ESSENTIAL FUNCTIONS:
1. Provides professional expertise and services that support the Care Delivery Division, including, but not limited to, the following.
a) Utilization management:
b) Credentialing:
c) Provider network:
d) Quality management and related initiatives:
2. Provides professional advice, guidance and support to other operational, analytical and strategic activities of the company, including, but not limited to, marketing, member services, claims, and public affairs.
3. Represents Affinity on appropriate local, State, and national trade groups, governmental and industry workgroups and committees and similar external venues; seeks opportunities to report on Affinity’s projects and programs.
4. Develops and maintains positive, constructive, mutually beneficial relationships that promote Affinity’s goal of being the “health plan of choice” for providers, consumers and purchasers.
QUALIFICATIONS:
1. License to practice medicine in New York State.
2. Board Certified Psychiatrist with Child and Adolescent Board Certification required.
3. Minimum of five (5) years of experience as an associate medical director or medical director working with utilization management, peer review, network assessment and provider relations, and quality improvement, preferably in an HMO environment. Working knowledge of clinical protocols, utilization review standards, and professional credentialing standards, policies and procedures.
4. General and managed care business knowledge demonstrated by:
5. Management, consultative and process skills required to initiate, implement and complete tasks and responsibilities in a timely manner, and to promote coordination of activities across departments or divisions.
6. Highly developed interpersonal and management skills, characterized by the ability to persuade, listen, interpret, negotiate, mediate, mentor, teach, consult and advise inside and outside of the organization, and to manage critical internal and external relationships.
7. Strong analytical skills, demonstrated by ability to identify and use qualitative and quantitative clinical and operational information and data to identify needs, select among competing approaches, make decisions, set priorities and monitor progress towards goals and objectives and desired outcomes.
8. Excellent writing and verbal communication skills characterized by the ability to articulate complex concepts and quantitative and qualitative information to diverse audiences.
9. Enthusiastic understanding and commitment to the corporate mission, vision, and values; understanding of, and sensitivity to, the needs, behaviors and expectations of a culturally diverse Member and provider population.
10. Demonstrated integrity, trustworthiness, respect for others, and ability to deal appropriately with confidential and sensitive information.
Full Time
Accommodations
$151k-188k (estimate)
05/23/2023
05/09/2024
affinityplan.org
BRONX, NY
500 - 1,000
1986
$200M - $500M
Accommodations
Affinity is an independent, not-for-profit organization founded in 1986 with one goal: to offer affordable, high quality health care coverage to underserved New Yorkers. As the first health plan licensed in New York State to serve publicly-sponsored populations, Affinitys vision and leadership resulted in many more people receiving the vital care they need. Over the last 30 years, weve grown from just a handful of members to over 250,000. Our Mission The mission of Affinity Health Plan is to improve the health and well-being of its Members, their families, and their communities in collaboratio ...
n with primary care providers. Our Vision Affinity strives to be the health plan of choice for its Members and its providers -- known for assuring access to high quality, cost-effective care; delivering the best customer experience; and contributing significantly to achieving a patient-centered health care system.
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