The Medical Management Team provides guidance and oversight of clinical services requested including authorization of services, clinical operations and overall clinical direction. The team is responsible for maintaining the clinical integrity of the program, including concurrent reviews of inpatient and rehabilitation services. The Associate Medical Director assists with clinical oversight of the organization and development of service definition criteria and other standards of care for application to care management and requests for services.
This position is primarily remote, with occasional on-site attendance as needed. Candidates residing in North Carolina or willing to relocate are strongly preferred; however, candidates seeking to remain out of state, preferably within the Eastern Time Zone, may be considered on a case-by-case basis. Weekend and holiday work may be required based on operational needs.
Responsibilities & Duties Assist with development of service criteria and other standards of care Make recommendations on the application of medical necessity criteria for service eligibility in regard to type, amount and duration of service Assist with developing the process to assess and document medical necessity Assist with the development and implementation of the utilization management plan Review approval and denial of service requests and Review the approval and denial of care ensuring protocols are in place and audits are completed by appropriately credentialed staff Assists in functions related to Utilization Management (UM), Quality Management (QM), Care Management (CM), Peer reviews, Appeals, and Reconsiderations Reviews and evaluates treatment procedures and outcomes of other psychiatrists and medical professionals in the community Analyzes and evaluates patient data and test findings to diagnose nature and extent of mental disorders Reviews consumer information and records, including social and medical history obtained from patients, relatives, and other professionals Collaborates with physicians, psychologists, pharmacists, social workers, psychiatric nurses, or other professionals to discuss treatment plans and progress Provide Consultation and Training Provides consultation as well as training and education to staff and community partners on relevant topics Manage and Develop staff May supervise other members of the Medical Management team Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes Organize workflows and ensure staff understand their roles and responsibilities Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements Actively establish and promote a positive, diverse, and inclusive working environment that builds trust Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Work to resolve conflicts and disputes, ensuring that all participants are given a voice Set goals for performance and deadlines in line with organization goals and vision Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development Cultivate and encourage efforts to expand cross-team collaboration and partnership Minimum Requirements Education & Experience Graduation from an accredited Medical School.
M. D./D. O. degree is required with completion of approved training in general psychiatry, child psychiatry and or addiction psychiatry and at least four (4) years of postgraduate clinical medical experience.
Special Requirement Current, active, and unrestricted license to practice medicine in North Carolina or able to obtain a North Carolina Medical License. Board certified by American Board of Psychiatry and Neurology Preferred Two (2) or more years of managed care and utilization management experience preferred. Knowledge, Skills, & Abilities Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures Knowledge of laws, legal codes, court procedures, precedents, government regulations Knowledge of Managed Care Principles Knowledge of recent developments in the field of medicine Microsoft Office Skills Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations Salary Range $211,172 - $269,245/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility Education Medical Doctor (required) Licenses and Certifications Medical Doctor (required)