Medical Director of Integrated Care (Remote-NC)

Company: Vaya Health
Location: Asheville
Posted on: November 19, 2024

Job Description:

LOCATION: Remote - must reside in North Carolina or within 40 miles of the North Carolina border. Must be willing to travel to the Asheville office if needed.

GENERAL STATEMENT OF JOBThe Medical Director of Integrated Care serves as a senior clinical consultant to the Chief Medical Officer (CMO) in ensuring proper provision of covered services to members and recipients and ensuring an integrated, whole-person approach to the behavioral and physical health of members and recipients with behavioral health, I/DD and TBI needs. The Medical Director of Integrated Care assists the CMO and Deputy Chief Medical Officer in developing and implementing clinical practice standards, clinical policies and procedures, population health and care management protocols, utilization management protocols, pharmacy processes, and quality management oversight.
Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONSClinical consultation, oversight and training to Care Management, Member and Recipient Services, Clinical Strategies, Transition and Housing, Provider Network Operations, and Legal and Compliance departments:Supervises specialty needs staffings, huddles, rounds, and other case escalations from care management staffServes as a clinical supervisor and resource for nursing staff throughout the organizationProvides clinical consultation for member appealsProvides clinical consultation including response for crisis calls and care coordination teamOffers supervision and training relevant to medical management of membersHelps develop key clinical indicators including process and outcome measuresOffers guidance and training of targeted clinical care goals such as disease prevention and management of chronic illnessProvides on-call coverage for clinical functions in the absence of the CMOCommunicates regularly with the CMO regarding clinical concerns and recommendationsCommunicates with physicians who provide direct care for members where complex factors require physician review and consultations to improve the capacity of the Network to create sustainable, positive outcomes
Quality Management and Pharmacy Operations clinical support and supervision:Provides clinical consultation for grievances, grievance appeals and the provider investigations teamCollaborates with CMO in analyzing data and developing interventions to improve member and community outcomesProvides support and supervision for the Clinical Quality team in developing review tools and technical assistance for providersSupports Pharmacy staff in all areas where physician consult is neededContact prescribers to support utilization of best practices in medication management and diagnostic testingAssists in training of Pharmacy students and other trainees
Utilization Management:Provides clinical consultation for Utilization Management in authorization decisionsProvides Initial Peer Reviews and Reconsideration and Appeal Reviews as appropriateRepresents Vaya's clinical team at the Office of Administrative HearingsProvides clinical consultation to UM Clinicians, and clinical supervision focusing on medical necessity, reasons for continued inpatient services, state requirements, and appropriate medical practiceProvides clinical training for UM staffSupports development & review of clinical best practices, decision tools and clinical practice guidelinesConducts analyses to identify service trends and patterns indicating medically unnecessary care
Community Collaboration:Meets with Regional and State Medical Leadership as directed by the CMOProvides consultation to providers and other community-based clinicians, including general practitioners and specialty providers. Consults with and acts as a liaison with area facilities, physicians, and agencies as requestedParticipates in Community Clinical Training EventsSupports Office of Communications in media requestsProvides Technical Support upon request
Committee Participation and Policy/Procedure Development:Serves as member of the Quality Improvement CommitteeServes as member of the Clinical Advisory CommitteeServes as member of the Critical Incident Review CommitteeReviews Policies and Procedures of Committees and Departments as appropriate
Human Resources Consultation:Assists with review and revision of Infection Control and Substance Use PoliciesProvide guidance on content of fitness for duty and return to work documentation
Other Duties as Assigned:Provides back-up and on-site availability to Vaya functions as assigned by the CMOAttends Vaya Board of Directors' meetings as neededResponds to consultation requests from Vaya staff

KNOWLEDGE OF JOBBroad knowledge of mental health disorders, developmental disabilities, traumatic brain injury and substance use disorders, and of appropriate interventions for those disordersKnowledge about consumers of different age and cultural groupsSkilled at providing consultation to other clinical staff, and must interact collaboratively and respectfully with Vaya staff, contracted providers, and other external stakeholdersAbility to interact professionally with providers, consumers, and stakeholders that may sometimes be upset and exhibit hostility toward Vaya and its staffAbility to quickly analyze the critical elements in given situations and provide clear and concise guidance regarding medically necessary and appropriate servicesNavigate, read information in and document in Vaya's Administrative Health Record, CRM systems, and any other systems as defined by Vaya policy QUALIFICATIONS & CREDENTIALING REQUIREMENTSMD or DO is required. Must also have:At least 5 years of experience in a clinical setting providing medical services, with at least 2 years of Managed Care experienceGraduate of an accredited university or medical school with a doctoral degree in medicineCompleted a residency training program in a primary care specialty, including family medicine, internal medicine, or pediatrics Specialty training in related areas, such as neurology or developmental pediatrics is also desirable Current or recent provision of psychiatric services for served disability groups is desirable. Licensure/Certification Requirements:Licensure: The Medical Director of Integrated Care must have a current, unrestricted North Carolina license to practice medicineCertifications: The Medical Director of Integrated Care must be Board Certified in Family Medicine, Internal Medicine, Pediatrics or a related primary or specialty care field. PHYSICAL REQUIREMENTSClose visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open until filled. APPLY: Vaya Health accepts online applications in our Career Center, please visit . Vaya Health is an equal opportunity employer.

Keywords: Vaya Health, Greenville , Medical Director of Integrated Care (Remote-NC), Healthcare , Asheville, South Carolina