Associate Medical Director

US-NC-Gastonia
1 week ago
Job ID
2017-1286
# of Openings
1
Category
Other

Overview

 

Excellent Benefits Package!!!

Projected Hiring Range:  To Be Determined

 

Closing Date: Open Until Filled

 

Primary Purpose of Position: The Associate Medical Director (AMD) in conjunction with the Chief Medical Officer provides medical leadership to the Clinical Operations Department.

 

Responsibilities

 

Role and Responsibilities:

  • Medical Necessity –The AMD will provide oversight for the application of Medical Necessity criteria for service eligibility (type of service, amount, duration), and development of process to assess and document medical necessity.
  • Authorization and Non-Authorization of authorization requests –Oversight for authorizations and non-authorization of services requests; ensure protocols are in place; and reviews are completed by appropriately credentialed staff. Monitors and ensures that the LME does not arbitrarily deny or reduce the amount, duration, or scope of a required service solely because of the diagnosis, type of illness or condition.
  • Practice Guidelines – Practice guidelines reflect evidence based and consensus based practices that are focused on achieving outcomes of self-determination, independence and recovery.
  • Utilization Management Procedures – Monitors and ensures that there are written UM procedures for the review of authorizations requests for each level of care, that are consistent with practice guidelines.
  • Utilization Management Plan Implementation –Insures that a utilization management plan is developed and implemented that reflects a utilization management program which monitors services authorized and used by consumers to ensure that consumers receive the care indicated and that consumers are moved to higher or lower levels of care as needed. Ensures consistency and integrity through formal procedures and clinical protocols that are developed in accordance with best practices, within state and federal requirements and medical necessity. Supervises and ensures the implementation of inter rater reliability training and assessment.
  • Care Management Activities – Consumer utilization of services as related to identified needs is monitored and follow up is provided on high risk cases to encourage involvement in treatment prior to deterioration or development of crisis situations, follow up after institutional or hospital discharge.
  • Quality Improvement Projects – Substantial involvement in the Quality Improvement/Performance Improvement program functions.
  • Stakeholder Relationships – Represent Partners BHM within physician and medical circles in order to establish relationships, for communication and to work through problems. Participate in community forums and with community advocacy agencies for educational activities.
  • Qualification of Providers – The AMD has substantial responsibility for credentialing/qualifying providers to ensure that services are provided by qualified providers. The AMD has oversight for monitoring of providers and subcontractors.
  • Adverse Incidents and Sentinel Events – Oversee management of incidents to ensure these are evaluated for severity, patterns, use of coercive interventions, as well as indicators for health and safety risks, abuse, neglect or rights violations.  

 

Knowledge, Skills and Abilities:

  • Extensive experience with public community mental health services and consumers with serious mental illness, co-occurring mental illness and substance abuse, children who are emotionally disturbed, as well as experience with developmental disabilities populations
  • Broad knowledge of medical, pharmacological, and service related supports needs of the population served in order to make decisions about need for care as well as to provide consultation and advice to other community physicians
  • Thorough knowledge of diagnostics and service definitions
  • Considerable knowledge of the laws, regulations, and policies that govern the program and its functions
  • Knowledge of managed care practices and principles
  • Knowledge of organizational resources and responsibilities within the community
  • Highly effective communication skills including the ability to express ideas clearly and concisely
  • Good computer skills
  • Ability to work collaboratively and effectively with other team members in order to develop processes, protocols, analyze data and solve problems
  • Ability to establish positive relationships with both the medical community and other key stakeholders
  • Ability to provide clinical supervision to advanced level clinicians
  • Ability to manage and uphold integrity and confidentiality of sensitive data

 

Qualifications

Education and Experience Required:

Completion of Medical school and completion of a residency in Psychiatry and child psychiatry are required. The physician must be Board Certified by the American Board of Psychiatry and Neurology. The physician must be licensed to practice in at least one state and obtain an unrestricted North Carolina license to practice medicine. Five years’ experience in psychiatry and child psychiatry and also experience in dealing with the intellectually/developmentally delayed population.

 

Education and Experience Preferred:

Managed care and community mental health experience, or experience with Medicaid and other publicly served population strongly preferred. At least five years of clinical experience is also preferred.

 

Licensure/Certification Requirements:

Board Certified by the American Board of Psychiatry and Neurology.

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