Alliance Behavioral Healthcare is seeking an Associate Medical Director to apply service definition criteria and other standards of care to requests for services. In the absence of the Medical Director, the Associate Medical Director assumes the responsibilities of the Medical Director.
The Associate Director is responsible for (though not limited to):
Assists the Chief Medical Officer in overseeing the application of medical necessity criteria for service eligibility in regards to type, amount and duration of service; and in developing the process to assess and document medical necessity;
Reviews the approval and denial of care ensuring protocols are in place and audits are completed by appropriately credentialed staff;
Assists in functions related to UM, UR, QM, CS, Credentialing, Peer reviews, Appeals, Reconsiderations and the like;
Assists the Chief Medical Officer in ensuring that a complete utilization management plan is developed and implemented;
Analyzes and evaluates patient data and test findings to diagnose nature and extent of mental disorders;
Collaborates with physicians, psychologists, pharmacists, social workers, psychiatric nurses, or other professionals to discuss treatment plans and progress;
Reviews consumer information and records, including social and medical history obtained from patients, relatives, and other professionals;
Teaches, participates in continuing education classes, attends conferences and seminars, and may conduct research and publish findings to increase understanding of mental, emotional, and behavioral states and disorders;
Reviews and evaluates treatment procedures and outcomes of other psychiatrists and medical professionals in the community;
Provides consultation as well as training and education to staff and community partners on relevant topics;
Serves as a member of The Credentialing Committee. In the absence of the Chief Medical Officer, the Credentialing Committee may delegate the authority to the Associate Medical Director(s) to review and approve credentialing applications that are complete and meet all requirements set forth in the credentialing plan. The Associate Medical Director will chair the Credentialing Committee in the absence of the Chief Medical Officer;
Assists in supervision of other members of the Medical team including Physician Peer Reviewer(s), Senior Psychologist, and Pharmacist.
Graduation from an accredited school of medicine and completion of residency or specialty training. Board certified or board-eligible psychiatrist, MD or DO, with a valid, unexpired, and unrestricted license to practice medicine in North Carolina, accreditation from the American Board of Psychiatry and Neurology, and at least four years of progressive medical and management experience in the field of mental health, developmental disabilities or substance abuse.
Additional Training Preferred: Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral, affective and substance use disorders as well as common physical health disorders.
Additional Salary Information: We offer an excellent salary and benefits package to include retirement, 401K, medical, dental, life and flexible work schedule
Alliance Behavioral Healthcare manages the public mental health, intellectual/ developmental disability and substance abuse services for over 200,000 Medicaid-eligible citizens within a total population of 1.7 million in Durham, Wake, Cumberland and Johnston counties.The Alliance vision is to be a leader in North Carolina in transforming the delivery of whole person care in the public sector. This... vision guides us on our mission to improve the health and well-being of the people we serve by ensuring highly effective, community-based support and care.Further shaping our work are our core organizational values of accountability and integrity, collaboration, compassion, dignity and respect, and innovation.Alliance manages a diverse network of over 2300 private service providers and strives to ensure a dynamic, collegial workplace that provides opportunity for growth, success and job satisfaction for its 400+ professional staff.Alliance has received full Health Network, Health Utilization Management, and Health Call Center accreditation from URAC.