General/Adult Psychiatry Job In North Carolina
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- 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.
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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:
Job ID#: DD-1703-71414
Enterprise Medical Recruiting, a leading physician, executive and advanced practice provider recruiting firm connects healthcare organizations with the most qualified, career-minded candidates. Our clients consist of hospitals, academic medical centers, integrated delivery systems and physician groups nationwide. Since 1990, Enterprise Medical Recruiting has been leading the physician recruiting market by offering an experienced staff and superior service to provide candidates and healthcare organizations with a positive and successful recruiting experience.