Medical Director of Integrated Care (Remote-NC)

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 JOB

The 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 FUNCTIONS

Clinical 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 staff
• Serves as a clinical supervisor and resource for nursing staff throughout the organization
• Provides clinical consultation for member appeals
• Provides clinical consultation including response for crisis calls and care coordination team
• Offers supervision and training relevant to medical management of members
• Helps develop key clinical indicators including process and outcome measures
• Offers guidance and training of targeted clinical care goals such as disease prevention and management of chronic illness
• Provides on-call coverage for clinical functions in the absence of the CMO
• Communicates regularly with the CMO regarding clinical concerns and recommendations
• Communicates 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 team
• Collaborates with CMO in analyzing data and developing interventions to improve member and community outcomes
• Provides support and supervision for the Clinical Quality team in developing review tools and technical assistance for providers
• Supports Pharmacy staff in all areas where physician consult is needed
• Contact prescribers to support utilization of best practices in medication management and diagnostic testing
• Assists in training of Pharmacy students and other trainees

Utilization Management:

• Provides clinical consultation for Utilization Management in authorization decisions
• Provides Initial Peer Reviews and Reconsideration and Appeal Reviews as appropriate
• Represents Vaya's clinical team at the Office of Administrative Hearings
• Provides clinical consultation to UM Clinicians, and clinical supervision focusing on medical necessity, reasons for continued inpatient services, state requirements, and appropriate medical practice
• Provides clinical training for UM staff
• Supports development & review of clinical best practices, decision tools and clinical practice guidelines
• Conducts analyses to identify service trends and patterns indicating medically unnecessary care

Community Collaboration:

• Meets with Regional and State Medical Leadership as directed by the CMO
• Provides 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 requested
• Participates in Community Clinical Training Events
• Supports Office of Communications in media requests
• Provides Technical Support upon request

Committee Participation and Policy/Procedure Development:

• Serves as member of the Quality Improvement Committee
• Serves as member of the Clinical Advisory Committee
• Serves as member of the Critical Incident Review Committee
• Reviews Policies and Procedures of Committees and Departments as appropriate

Human Resources Consultation:

• Assists with review and revision of Infection Control and Substance Use Policies
• Provide 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 CMO
• Attends Vaya Board of Directors' meetings as needed
• Responds to consultation requests from Vaya staff

KNOWLEDGE OF JOB

• Broad knowledge of mental health disorders, developmental disabilities, traumatic brain injury and substance use disorders, and of appropriate interventions for those disorders
• Knowledge about consumers of different age and cultural groups
• Skilled at providing consultation to other clinical staff, and must interact collaboratively and respectfully with Vaya staff, contracted providers, and other external stakeholders
• Ability to interact professionally with providers, consumers, and stakeholders that may sometimes be upset and exhibit hostility toward Vaya and its staff
• Ability to quickly analyze the critical elements in given situations and provide clear and concise guidance regarding medically necessary and appropriate services

QUALIFICATIONS & CREDENTIALING REQUIREMENTS

MD 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 experience
• Graduate of an accredited university or medical school with a doctoral degree in medicine
• Completed 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 medicine
• Certifications: 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 REQUIREMENTS

• Close 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 https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.