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Duties/Responsibilities:

+ Lead, mentor, and support the HARP Care Management team, ensuring high clinical quality, member satisfaction, and employee engagement

+ Drive innovation in integrated care models that align with NYS Medicaid requirements and Healthfirsts quality and value-based care goals

+ Champion initiatives that elevate the integration of behavioral health with physical health and social determinant support services

+ Design and implement efficient and effective clinical programs, workflows, and policies that address the comprehensive needs of HARP members, including transitions of care and housing support

+ Evaluate program outcomes, identify gaps in care, and implement performance improvement strategies using clinical, utilization, and quality data

+ Partner with departments across Healthfirst, including Medical Management, Population Health, Clinical Quality, Delivery Systems Engagement (DSE), and Analytics & Reporting, to ensure coordination of member care

+ Serve as the clinical subject matter expert on business development efforts related to behavioral health programs, including the launch of new products or regulatory initiatives

+ Act as a public-facing clinical leader with community partners, state agencies, and provider organizations

+ Represent Healthfirst on local, state, and industry workgroups, helping to shape behavioral health best practices

+ Ensures all NY state and federal compliance, audit and regulatory requirements are met

+ Perform other duties as necessary or assigned

MinimumQualifications:

+ NYS license as a Psychiatric-Mental Health Nurse Practitioner (PMHNP), or Licensed Clinical Social Worker (LCSW), or Licensed Master Social Worker (LMSW)

+ 7 years of behavioral health experience in managed care and/or a clinical setting with at least 2 years of that experience being in managed care

+ Progressive leadership experience in medical and behavioral health care management including work experience in a senior management role

+ Work experience and deep familiarity with New York State HARP, HCBS, and Medicaid Managed Care programs

Preferred Qualifications:

+ Clinical and leadership experience as a Psychiatric-Mental Health Nurse Practitioner (PMHNP)

+ Proven ability to lead complex teams and manage interdisciplinary care models in a health plan or integrated delivery system

+ Demonstrated experience with regulatory compliance, clinical quality improvement, and care management

+ Advanced proficiency in Microsoft Office (Word, Excel, PowerPoint) and ability to leverage data to inform strategy

+ Exceptional written, verbal, and presentation skills; capable of influencing internal and external stakeholders

+ Strategic thinker with strong operational discipline and capacity for executive-level decision-making

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.