Cardinal Innovations Healthcare provides access to Medicaid and state-funded benefits, providers and supports for more than 850,000 individuals with complex needs. Using a community-based model of care management, Cardinal Innovations seeks to improve the health and wellness of its members by collaborating with local providers and stakeholders. Recognized for operational excellence, innovative solutions and superior outcomes for members, as well as accuracy and speed of payments to providers and cost-effective funds management, Cardinal Innovations is a leading managed care organization proud to serve North Carolina’s most vulnerable citizens.
Primary Purpose of Position:
The Regional Medical Director has primary responsibilities for promoting high level quality and clinical integrity of the utilization management activities for the special populations served by Cardinal Innovations. These activities include promoting access to best practice treatment modalities for the membership, oversight of a high quality provider network and skilled Cardinal based clinical team. The Regional Medical Director will provide medical leadership for Cardinal Innovations by working with the Chief Medical Officer, the Medical Department and Quality and Clinical Leadership at the Vice President level at a minimum to provide medical and quality oversight for Cardinal Innovations clinical operations. The Regional Medical Director shall be responsible for the proper authorization and review of covered services to enrollees, ensuring that employees conducting authorization reviews operate within the scope of their clinical expertise, and that services provided are both medically necessary and provided by qualified providers. Cardinal Innovations serves a 20-county region of North Carolina which spans the I-85 corridor from Virginia to South Carolina. The Regional Medical Director will serve in geographic regions within the 20-county area to be determined. Particular focus and planning is directed within the specified region and the director will ensure alignment with the overall Cardinal Innovations strategic plan.
The Regional Director reports to the Chief Medical Officer (CMO) and will assist in identifying and developing emerging/innovative strategies for improving and expanding clinical lines of business for the company including activities such as strategic planning, managing strategic clinical and other business relationships, partnering in the development of clinical analytics, and participating in quality improvement oversight and activities.
Responsibilities and Duties:
Knowledge, Skills and Abilities:
This position requires a high degree of attention to detail, ability to be flexible and responsive to rapidly changing conditions, ability to exercise a high degree of schedule management, and ability to triage and prioritize responsibilities and demands.
Experience with public community mental health services and consumers with serious mental illness, co-occurring mental illness and substance abuse, children with mental health conditions, as well as experience with developmental disabilities populations is very important.
The employee must have a wide knowledge of medical, pharmacological, and service -related supports needs of these populations in order to make decisions about need for care as well as to provide consultation and advice to other community physicians.
Employee must have a high degree of clinical skill set as it relates to Psychiatric, Medical, Substance Use and Intellectual/Developmental Disabilities as well as an ability to manage complex psychiatric and medical conditions.
The employee must be able to work collaboratively and effectively with both internal and external customers in order to develop processes, protocols, analyze data, and solve problems.
This is a high profile leadership position and it is important for the employee to be able to establish positive relationships with both the medical community and other key stakeholders.
The employee must be self-directed, able to organize and prioritize work, obtain and access needed information, interpret complex written materials, and be able to discriminate between essential and non-essential tasks.
Required Training and Education:
Completion of Medical school and completion of a residency in Psychiatry is required. The physician must be Board Certified or Board Eligible for Psychiatry certification by the American Board of Psychiatry and Neurology. The physician must be licensed to practice in at least one state and obtain an unrestricted North Carolina license to practice medicine. Managed care and community mental health experience, or experience with Medicaid and other publicly served population required. At least two years of post-graduate clinical experience is also required.
This is an office-based position which primarily occurs during normal business hours. Cardinal Innovations reserves the right to call upon this employee during non-business hours as needed to meet the demands of the position.