Associate Medical Director-UM Reviews & Appeals

Associate Medical Director-UM Reviews & Appeals

Join to apply for the Associate Medical Director-UM Reviews & Appeals role at Partners Health Management.

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company‑paid life and disability insurance
• Wellness programs
• Public Service Loan Forgiveness qualifying employer

Office

Location:

Available for any of Partners' NC locations

Projected Hiring Range: Depending on experience

Closing Date: Open until filled

The Associate Medical Director serves as a senior clinical consultant to the Deputy Chief Medical Director and Chief Medical Officer, ensuring provision of covered services and an integrated whole‑person approach to behavioral and physical health for members with behavioral health, I/DD and TBI needs.

• Supervise specialty needs staffing, huddles, rounds, and case escalations from care management staff.
• Serve as a clinical supervisor and resource for nursing staff organization‑wide.
• Provide clinical consultation for member appeals and crisis calls.
• Offer supervision and training in medical management of members.
• Help develop key clinical indicators and process/outcome measures.
• Provide on‑call coverage for clinical functions in the absence of the Deputy CMD.
• Communicate regularly with the Deputy CMD regarding clinical concerns and recommendations.
• Assist physicians in reviewing complex factors for improving network outcomes.

• Consult on grievances and provider investigations, and support clinical quality team.
• Collaborate with CMO and DCMD in data analysis and intervention development.
• Support pharmacy staff on medication management and utilization best practices.

• Consult on utilization management authorization decisions.
• Provide initial peer reviews, reconsiderations, and appeal reviews.
• Conduct medical necessity reviews and training for UM staff.
• Develop clinical best practice guidelines and decision tools.
• Analyze trends to identify medically unnecessary care.

• Meet with regional and state medical leadership.
• Consult with providers and community clinicians.
• Participate in community clinical training events.
• Other duties as assigned.

• Broad knowledge of mental health disorders, developmental disabilities, TBI, and substance use disorders.
• Understanding of diverse consumer populations.
• Strong consultation skills; respectful collaboration with staff, providers, and stakeholders.
• Professional interaction with potentially upset or hostile individuals.
• Analytical ability to provide clear guidance on medically necessary services.

• Minimum 5 years of clinical health experience providing medical services.
• Minimum 2 years of managed care experience.
• Doctoral degree (MD) from an accredited university or medical school.
• Residency in primary care specialty (family medicine or internal medicine).
• Clinical experience with child/adolescent and adult populations.
• Must reside in North Carolina.

Unrestricted NC Medical license (MD); must be a primary care physician fully licensed to practice in NC and in good standing.

Referrals increase your chances of interviewing at Partners Health Management by 2x.

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