New Leadership Opportunity in Behavioral Health - North Carolina

NORTH CAROLINA: Alliance Behavioral Healthcare is seeking a Chief Medical Officer to ensure delivery of cost effective, quality care that incorporates recovery, resiliency and person-centered services. Alliance Behavioral Healthcare manages the public mental health, intellectual/ developmental disability and substance abuse services for the citizens of Durham, Wake, Cumberland and Johnston counties. Although we do not actually provide services, our job is to ensure that individuals who seek help receive the quality services and supports they are eligible for to help them achieve their goals and live as independently as possible. These services are delivered by a network of private providers who contract with Alliance. 'The Chief Medical Officer is responsible for (though not limited to):

• Maintaining the clinical integrity of the program, including concurrent reviews of inpatient and rehabilitation services; providing oversight to utilization management and quality staff and providing consultation to providers and other community-based clinicians, including general practitioners.
• Medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews and clinical best practices guideline development.
• 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.
• 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.
• Providing clinical leadership to Care Management, Access Care Coordination and Quality Management staff. 'May provide clinical supervision/in-service training to clinical staff focusing on medical necessity, reason(s) for continued inpatient services, state requirements, appropriate psychiatric practice and engagement, empowerment, recovery and rehabilitation.
• Providing peer to peer reviews and consultations. 'Act as liaison with area facilities, physicians and agencies as requested.
• Reviewing 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.
• Establishing 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 best practices.
• Providing 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.
• Conduct clinical reviews of contracted provider clinical records as requested. 'Participate in Quality Assurance activists and audits.
• Oversight of the clinical aspects of the credentialing program. 'This includes Chairing the Credentialing Committee, reviewing all Credentialing applications and approving status. 'The Credentialing Committee may delegate the authority to the Chief Medical Officer to review and approve credentialing applications that are complete and meet all requirements set forth in the credentialing plan when the Committee is unable to meet. 'May meet with potential providers to review clinical, safety, background check and sanction issues if deemed needed.

Our Community:

Named as one of the best places for attracting families as well as for doing business, Raleigh, Wake County, and the Triangle area frequently top national and international rankings from publications that include Money, Forbes, and Bloomberg. Our innovative culture and strong talent appeal to businesses and around the globe. Discover the unique lifestyle that entices families and singles, along with a growing community that offers prosperous careers.

If you are a board-certified Psychiatrist, with at least four years of clinical experience and interested in a new career opportunity in helping lead our organization in the ever-changing world of behavioral healthcare, please contact:

Dave Duncan
800-467-3737
dduncan@enterprisemed.com
www.enterprisemed.com

Job ID#: DD-1703-71414