Behavioral Health Medical Director, Health and Recovery Plan, Fidelis Care New York

• 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
• Develops, implements, and conducts concurrent and retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care
• Ensures that the medical care provided meets the standards for acceptable medical care
• Fosters Clinical Practice Guideline implementation and evidence-based medical practice
• Participates in performance and quality based on changes in the healthcare or medical arena
• 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

Desired Skills and Experience:

• Doctorate Degree in Medicine
• Board Certified in Psychiatry (ABPN), preferred
• Current Medical license in NYS without restrictions and free of sanctions from Medicaid or Medicare
• Minimum three years of clinical experience with minimum two years of BH managed care experience
• Certification in Addiction Medicine or certification in the subspecialty of Addiction Psychiatry required

Fidelis Care, a $6 billion health care company, offers quality, affordable coverage to residents across the State of New York, including products available through Medicaid, Medicare, and the NY State of Health. Fidelis Care was founded on the belief that all New Yorkers should have access to affordable, quality health insurance and that remains our mission to this day to our 1.2 million members.