The Associate Medical Director, Utilization Management is responsible for assisting the Medical Director in the oversight of Utilization Management (UM) programs and will support the development and maintenance of these programs, with focus on clinical accuracy and appropriateness. The Associate Medical Director (AMD) will assist the Medical Director in the efforts to develop strategic corporate direction / focus for UM programs. The AMD will support the Medical Director and VP of Medical Management in preparing annual metrics of results of UM programs. The AMD contributes to the provision of measureable outcomes for prior authorization, step therapy and quantity limit programs.
The AMD will collaborate with internal teams to support corporate HEDIS initiatives with appropriate clinical program development. The AMD is expected to work closely with clinical program development teams, clinical service operations and clinical quality committees and provide clinical guidance and oversight to these areas. The AMD shall also serve on IH committees as directed by the Medical Director.
Must be a graduate of an accredited medical school and residency program.
Board certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS), preferably in Primary Care (internal medicine, family practice, etc.).
Possess an unrestricted, active license to practice medicine, issued by the NY State Board of Licensure or the State Board of Osteopathic Examiners. Must be a member in good standing in the medical community.
Master’s degree in healthcare administration, business or public health preferred.
Minimum of two years relevant experience in health care management and utilization review required; quality assurance and peer review experience preferred.
Private practice experience preferred.
Excellent verbal, written and interpersonal communication skills required.
Solid computer navigational skills required.
Demonstrated ability to work effectively as a member of a multi-disciplinary team.
Demonstrated ability to analyze, interpret and communicate significance of health care data.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Independent Health reserves the right to change job descriptions as necessary.
Independent Health is an equal opportunity employer.