Medical Director

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Medical Director to join our growing team.

Job Summary:

The purpose of the Medical Director position is to provide the principal senior clinical leadership and clinical expertise to operations on all medical aspects relating to the peer review process, utilization review activities, case management, and/or other activities requiring clinical leadership and consultation for the Maine Administrative Services Organization (ASO) which clinical reviews behavioral health and substance use services.

The Medical Director serves as the senior clinical authority for the program and must be a licensed psychiatrist with an active, unrestricted license in the State of Maine.

Additional key responsibilities may include assisting and promoting business development and strategic planning activities.

In addition to internal clinical leadership responsibilities, the Medical Director is responsible for representing Acentra Health on all reconsideration decisions involving adverse determinations and serves as the designated clinical representative for the State of Maine and Acentra Health during administrative appeal hearings. This includes providing independent clinical judgment, written medical necessity determinations, and oral testimony as required.

The Medical Director ensures that all clinical decisions are evidence-based, defensible, and compliant with applicable state and federal regulations, Maine Care policy, accreditation standards, and Acentra Health policies and procedures.

This position is remote; however, candidates must be a licensed psychiatrist with an active, unrestricted license in the State of Maine

Job Responsibilities:

• Responsible for oversight of clinical decision-making aspects of the program and provides clinical guidance.
• Evaluate, and/or respond to inquiries from physicians, providers, and customers.
• Consult with general and/or specialty practitioners regularly and as necessary as business needs require.
• Represent and promote company and Acentra Health at seminars, professional societies, hospital medical staff meetings, and other professional settings as appropriate.
• Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, speaking engagements before physician and provider organizations.
• Analyze and remain current on national, state, and local regulations and legislation including Maine Care policy and federal behavioral health requirements, which impacts the health care profession.
• Review medical information trends, experiences, and approaches, and assists in the development of strategic plans for clinical improvements.
• Ensures compliance with regulatory and accreditation requirements including URAC and applicable state and federal standards.
• Responsible for oversight of medical content of company publications and clinical guidance documents.
• Participate in activities specific to contractual arrangements, i.e., Fair Hearings, including serving as the clinical representative for Acentra Health and the State of Maine in administrative appeal hearings and reconsideration processes related to adverse determinations.
• Provide medical expertise with respect to planning and establishing goals and policies to improve medical management.
• Provides oversight of physician consultants and advisors. Conducts peer-to-peer physician consultations as requested/required, documents consultations and renders…