Chief Medical Officer at Alliance Behavioral Healthcare

Posted in Management 23 days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Morrisville, North Carolina





Job Description:

Alliance Health is seeking a Chief Medical Officer to provide guidance, leadership and oversight of clinical services including authorization of services, clinical operations and the overall clinical direction of Alliance. The Chief Medical Officer is responsible for maintaining the clinical integrity of the program, including oversight of utilization management, quality management, credentialing, utilization management, and best practice guideline development. The Chief Medical Officer may also consult with service providers and other community based clinicians, including general practitioners.

This position is responsible for ensuring delivery of cost effective, quality care that incorporates recovery, resiliency and person-centered services.

Responsibilities and Duties


  • Provide oversight to Utilization Management (UM), Care Coordination, Access and Quality Management staff

  • Provide consultation to providers and other community based clinicians, including general practitioners

  • Responsible for medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews, and clinical best practices guideline development

  • Responsible for achieving appropriate utilization by performing peer reviews and rendering determinations of clinical criteria no longer met for continuation of services; consulting with care management staff; using data to identify opportunities for improvement and implementing strong action plans

  • Responsible for implementing a recovery philosophy, maintaining a knowledge base in rehabilitation and recovery principles and innovations; modeling principles of engagement, empowerment and learning with colleagues and employees, and training all staff in the practical implications of these principles with a particular emphasis on care management, alternative levels of care and network sufficiency

  • Provide clinical leadership to Care Management, Access, Care Coordination and Quality Management staff

  • May provide clinical supervision to clinical staff focusing on medical necessity, reason(s) for continued inpatient services, state requirements, appropriate psychiatric practice and engagement, empowerment, recovery and rehabilitation

  • Provide in service training for staff on managed care and general clinical issues in order for staff to understand direct service vs. care management in a managed care environment

  • May consult with and act as a liaison with area facilities, physicians, and agencies as requested

  • Review reports on UM activities. Complete all medical necessity reviews when Care Managers are unable to authorize inpatient or rehabilitation continued stay. Provide sufficient electronic documentation in the consumer record when a denial is made for either adult or child/adolescent

  • Establish criteria and procedures for the Chief Medical Officer Review of clinical cases. Provide consultation to Alliance Management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and audits

Requirements

Graduation from an accredited school of medicine and completion of residency or specialty training, board-certified psychiatrist, M.D. or D.O. with an unrestricted clinical license, and four (4) or more years’ experience providing psychiatric services. Must hold an unencumbered North Carolina medical license and be board certified or board eligible in psychiatry.

Experience with government programs, Medicaid and Managed Care policy administration, and health plans highly preferred.

Salary Range

$192,452 - $331,302

Licenses & Certifications


Required


  • Driver License

Skills


Required


  • Advising

  • Critical Thinking

  • Evaluating

  • Futuristic Thinking

  • Leadership

Behaviors


Preferred


  • Loyal: Shows firm and constant support to a cause

  • Innovative: Consistently introduces new ideas and demonstrates original thinking

  • Thought Provoking: Capable of making others think deeply on a subject

  • Team Player: Works well as a member of a group

  • Leader: Inspires teammates to follow them

  • Functional Expert: Considered a thought leader on a subject

  • Enthusiastic: Shows intense and eager enjoyment and interest

  • Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations


Preferred


  • Job Security: Inspired to perform well by the knowledge that your job is safe

  • Financial: Inspired to perform well by monetary reimbursement

  • Goal Completion: Inspired to perform well by the completion of tasks

  • Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals

  • Self-Starter: Inspired to perform without outside help

  • Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

See job description