Medical Director - Physical Health

The Medical Management Team provides guidance and oversight of clinical services requested including authorization of services, clinical operations and overall clinical direction. The team is responsible for maintaining the clinical integrity of the program, including concurrent reviews of inpatient and rehabilitation services.

The Associate Medical Director assists with clinical oversight of the organization and development of service definition criteria and other standards of care for application to care management and requests for services.

This position is primarily remote, with occasional on-site attendance as needed. Candidates residing in North Carolina or willing to relocate are strongly preferred; however, candidates seeking to remain out of state, preferably within the Eastern Time Zone, may be considered on a case-by-case basis. Weekend and holiday work may be required based on operational needs.

Assist with development of service criteria and other standards of care

• Make recommendations on the application of medical necessity criteria for service eligibility in regard to type, amount and duration of service
• Assist with developing the process to assess and document medical necessity
• Assist with the development and implementation of the utilization management plan

Review approval and denial of service requests and

• Review the approval and denial of care ensuring protocols are in place and audits are completed by appropriately credentialed staff
• Assists in functions related to Utilization Management (UM), Quality Management (QM), Care Management (CM), Peer reviews, Appeals, and Reconsiderations
• Reviews and evaluates treatment procedures and outcomes of other psychiatrists and medical professionals in the community
• Analyzes and evaluates patient data and test findings to diagnose nature and extent of mental disorders
• Reviews consumer information and records, including social and medical history obtained from patients, relatives, and other professionals
• Collaborates with physicians, psychologists, pharmacists, social workers, psychiatric nurses, or other professionals to discuss treatment plans and progress

• Provides consultation as well as training and education to staff and community partners on relevant topics

• May supervise other members of the Medical Management team
• Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Ensure all staff are treated with respect and dignity
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• Set goals for performance and deadlines in line with organization goals and vision
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
• Cultivate and encourage efforts to expand cross-team collaboration and partnership

Graduation from an accredited Medical School. M.D./D.O. degree is required with completion of…