Medical Director

Position Title: Medical Director (Onsite)

Supervisor: Chief Executive Officer

FLSA Classification: Exempt

GENERAL REQUIREMENTS/QUALIFICATIONS

COMPETENCIES:

• Analytical: This individual interprets, records and records complex and diverse information. 
• Planning/organizing: This individual prioritizes utilization reviews, uses time efficiently and manages conflicting priorities in an effective manner.  
• Quality management: Maintains confidentiality of client records.

ESSENTIAL FUNCTIONS/ BASIC DUTIES:

• Reviews patient insurance benefits.
• Assesses treatment plans and ensures they are implemented.
• Evaluates the treatment needs of clients, in conjunction with the clinical and medical staff.
• Provides quality control, related to patient treatment, ensuring that staff provides adequately for patient comfort, health and safety.
• Prepares assessments and communication updates in a timely and professional manner
• Ensures strict adherence to Phoenix Employee Solutions policies and federal confidentiality laws.
• Updates supervisor with all pertinent utilization review information.
• Understands jobs functions, and scope of practice, for all clinical and medical personnel.
• Establishes and maintains positive and effective communication with managed care companies.

MINIMUM EDUCATION AND REQUIREMENTS: 

• Comprehensive knowledge of all levels of all levels of substance abuse care (Medical Detox, PHP, IOP, OP)
• Firm understanding of general medical necessity criteria for each level of substance abuse treatment care
• Knowledge of clinical interventions, diagnostics and ASAM criteria for defining levels of care in a behavioral health setting.
• Familiar and accustomed to working with insurance specific criteria
• Proven experience in conceptualizing a case, and creating a clinical impression to present to Managed Care representatives
• Knowledge of managed care and reimbursement principles
• Experience with admission data reviews to determine medical necessity and appropriateness of admission based upon approved criteria and standards
• Experience conducting random continuing-stay reviews to ensure patients in treatment require, and are benefiting from, the services they are receiving
• Experience in developing UR statistics and reports
• Excellent interpersonal skills
• Collaboration and negotiation skills
• Proficient in problem-solving and the continuous improvement process.
• Effective data management, computer skills.

REQUIRED LICENSES OR CERTIFICATIONS 

• LMHC, LCSW, LMFT, ARNP, PA, or RN required

PHYSICAL DEMANDS/ WORK ENVIRONMENT REQUIREMENTS 

TYPICAL WORKING CONDITIONS: 

Work is typically performed in an enclosed office and/or cubicle setting.

EMPLOYER’S RIGHTS:

This job description does not list all the duties of the job. Incumbents may be asked by their supervisor to perform other duties.  Incumbents will be evaluated in part based upon their performance of the tasks listed in this job description.

The Company has the right to revise this job description at any time.  The job description is not a contract for employment, and either you or the Company may terminate employment at any time, with or without cause, with or without notice (subject to applicable laws).