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
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.
$192,452 - $331,302
Licenses & Certifications
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
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