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Centene Corporation Medical Director (HARP) in Rego Park, New York

Position Purpose:

The Health and Recovery Program (HARP) Behavioral Health Medical Director provides clinical leadership and support for the development and implementation of the HARP plan in the Quality HealthCare Management Department (QHCM).

  • Leads, develops, directs and implements clinical and non-clinical development of the HARP implementation following NYS directives and guidelines.

  • Develops, Implements and Conducts the evaluation of authorization requests in timely manner and provide support for the CM and RN reviewers and manages the denial process.

  • Participates in performance and quality based on changes in the healthcare or medical arena.

  • Fosters Clinical Practice Guideline implementation and evidence-based medical practice.

  • Interprets existing policies and participates in developing new policies.

  • Participates as needed in regulatory, professional and community activities to provide input and become knowledgeable regarding regulatory, professional and community standards and issues.

  • Ensures that the medical care provided meets the standards for acceptable medical care.

  • Develops, Implements and Conducts concurrent and retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.

Education/Experience:

Doctorate Degree in Medicine. Minimum 10 years of clinical experience with minimum 2 years of BH managed care experience. Good interpersonal communication skills and collaborative ability. Able to use systematic techniques to define problems, options, and solutions; evaluate alternative solutions; solve technical problems using logic. Ability to maintain attendance to support required quality and quantity of work with the ability to work remotely. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

License/Certification:

Doctorate Degree in Medicine. Board Certified in Psychiatry (ABPN). Current Medical license in NYS without restrictions and free of sanctions from Medicaid or Medicare. Board Certification in Addiction Medicine strongly preferred. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. TITLE: Medical Director (HARP) LOCATION: Rego Park, New York REQNUMBER: 1223215 COMPANY: Clinical & Care Management POSITION TYPE: Both

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