Associate Medical Director - UM Part-time

Independent Health Association•Buffalo, NY

4d•Remote

About The Position

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 SVP, Healthcare Services in preparing annual metrics of results of UM programs. The AMD contributes to the provision of measurable 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.

Requirements

Graduate Degree required from an accredited medical school and residency program required.
Possess an unrestricted, current, 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.
Five (5) years of post-graduate clinical experience in health care management and utilization review required.
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.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Nice To Haves

Master’s degree in healthcare administration, business, or public health preferred.
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.) preferred.
quality assurance and peer review experience preferred.
Private practice experience preferred.

Responsibilities

Ensure that all UM decisions made are consistent with the terms of our member contract.
Ensure that all UM decisions represent services that are medically necessary.
Ensure all UM decisions are consistent with approved IH and regulatory policies.
Ensure that appropriate information is available to determine medical necessity for approved services.
Ensure that reviews are appropriately completed within regulatory time frames.
Work with the UM leadership to ensure accuracy, consistency, and efficiency of the UM process.
Assist the UM leadership in the development of performance reporting.
Collaborate with internal teams to support corporate HEDIS initiatives.
Support UM leadership to improve clinical service operations.
Serve on Independent Health committees as appropriate or as designated by Medical Director.