Deputy Chief Medical Officer

The Deputy Chief Medical Officer (DCMO) oversees and is responsible for supporting the Chief Medical Officer (CMO) in ensuring proper provision of services and ensuring an integrated approach to the physical and behavioral health of members and recipients, including those with I/DD and TBI needs. The Deputy Chief Medical Officer will apply evidence-based criteria in their oversight of physical health utilization management and care management. The DCMO will also manage some functions delegated by the CMO for clinical operation of Alliance Health.

This position will offer a flexible schedule which will include the ability to work remote certain days of the week. The successful candidates must be a resident of North Carolina or willing to relocate.

Responsibilities & Duties

Provide Clinical Oversight to the organization

• Oversee proper provision of covered Medicaid and State-funded services to Members, as assigned by the Chief Medical Officer.
• Maintain efficient operations while ensuring attainment of quality of care and financial goals.
• Provide clinical leadership and oversight to the organization, including Utilization Management, Care Management, Access, Care Coordination, Network and Quality Management staff.  
• Oversee the development of evidence based clinical best practices, policies, and practices.
• Provide consultation to Alliance Management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices. 
• Provide clinical supervision to clinical staff focusing on medical necessity, reason(s) for continued inpatient services, state requirements, appropriate medical practice and engagement, empowerment, recovery and rehabilitation. This responsibility includes peer review for utilization management and case escalation consultation for care management.
• Conduct analyses to identify service trends and patterns indicative of inappropriate, unreasonable, or medically unnecessary care.
• Oversee clinical data analytics, including helping train staff and providers on understanding on how to analyze and use data and information. 
• Help develop key clinical indicators including structural, process and outcomes measures.
• Use data to identify opportunities for improvement and implementing strong action plans.
• Supports the organization to ensure an integrated approach to the physical and behavioral health of members and recipients, including those with I/DD and TBI needs.

• Oversee appropriate utilization by ensuring peer reviews and determinations meet clinical criteria and guidelines.

• Conduct clinical reviews of contracted provider clinical records as requested.  

Develop Clinical practice standards

• Develop Clinical Practice standards for Medicaid Managed Care Program and State-funded services.
• Establishing and implement standards and policies to ensure the quality of the medical care provided to patients
• Responsible for 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.

Manage and develop staff

• Responsible for establishing and implementing a safe working environment that meets all licensure, regulatory, and accreditation requirements.
• Work with Human Resources and CMO to maintain highly qualified and well trained staff.  
• Provide in service training for staff on managed care and general clinical issues including helping staff to understand direct service vs. care management in a managed care environment.,
• Monitor and manage staff productivity.
• Ensure staff are well trained in Alliance policies, procedures, and business processes.
• Ensure the department has the needed tools to fulfill functions and support employees
• Provides ongoing coaching and mentoring to staff and support a learning environment to advance team skills

Develop and Implement Clinical Policies and Procedures

• Support the maintenance of evidence-based clinical protocols and policies to enhance the quality of medical necessity decision-making. 
• In consultation with the Chief Medical Officer establish criteria and procedures for review of clinical cases.
• Develop and Implement Clinical Policies and Procedures
• Responsible for medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews, and clinical best practices guideline development.

Collaborate and Provide Consultation

• Participates in the development of Alliance’s benefit plan for Medicaid members and state-funded recipients.
• Provide advice and counsel to Executive leadership on medical and administrative matters.
• Participate in committees that support organizational goals and best clinical practice including internally-facing groups and provider or member-facing groups.
• Works with executive and senior management to establish goals and needs for Clinical Operations.
• Partner closely with all stakeholders to develop and implement initiative task plans that enable optimal outcome in regards to improved patient outcomes and member access, quality and satisfaction.
• Participate in building coalitions internally and with other federal, state, and local governments, nonprofit and private sector organizations.
• Provide consultation to providers and other community-based clinicians, including general practitioners. May consult with and act as a liaison with area facilities, physicians, and agencies as requested.

Ensure compliance with applicable regulatory and accreditation requirements.

Minimum Requirements

Psychiatrist fully licensed to practice in North Carolina and in good standing with a minimum of five (5) years’ experience in a BH and/or I/DD clinical setting and two (2) years’ experience in managed care. Clinical experience with child mental health or addition/SUD preferred.

Must reside in North Carolina or be willing to relocate.

Knowledge, Skills, and Abilities

• Thorough knowledge of the theory, principles, and practices of general, preventive, and applicable specialty medicine and of the techniques involved.
• Thorough knowledge of the developments in the field of medicine.
• Considerable knowledge of stat, organizational, and medical rules and regulations.
• Thorough knowledge of biological, social and psychological development process of patients served.
• Thorough knowledge of techniques of interviewing and counseling, assessment and evaluation of medical histories and presenting problems, principles and practices of medicine, appraisal tools, laboratory tests and findings, and knowledge of how to plan and carry out a regimen of care and treatment
• General knowledge of planning, budgeting and policy making processes.
• Knowledge of cultural awareness and differences, and the ability and sensitivity to work with and/or serve a diverse population.
• Skill in leadership, teaching and management techniques.
• Ability to lead interdisciplinary teams.
• Ability to compile clear and concise notes for patient’s charts and to make oral presentations of cases in medical conference.
• Ability to guide work performance of physicians with limited experience.
• Ability to establish and maintain effective working relationships with associate personnel, consumers, and their families and the general public.
• Excellent skills in the medical assessment/ evaluation.
• Ability to record accurately and completely all information necessary to evaluate and plan care and treatment.
• Ability to communicate information accurately
• Ability to speak with colleagues about treatment concerns and/or recommendations.

Required License

Active, unencumbered NC Medical license

Salary Requirement 

$223,000.06 to $383,888.82/Annually 

Salary offer will be commensurate with experience. An excellent fringe benefit package accompanies the salary, which includes: 

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility