Associate Medical Director - UM

Independent Health•Buffalo, NY

1d•$250,000 - $300,000•Hybrid

About The Position

The Associate Medical Director, Utilization Management (UM), assists the Medical Director in overseeing UM programs and supports their development and maintenance, with a focus on clinical accuracy and appropriateness. The role contributes to strategic direction for UM programs and supports the SVP, Healthcare Services in preparing annual program metrics. It also helps produce measurable outcomes for prior authorization, step therapy, and quantity limit programs. The Associate Medical Director collaborates with internal teams on corporate HEDIS initiatives and appropriate clinical program development. The role works closely with clinical program development teams, clinical service operations, and clinical quality committees, providing clinical guidance and oversight. The Associate Medical Director also serves on Independent Health committees as directed by the Medical Director. This is a hybrid position requiring onsite attendance at the Williamsville location. The position includes rotating in the UM call schedule to provide remote coverage during evenings, weekends, and holidays. Immigration or work visa sponsorship is not provided.

Requirements

Graduate degree from an accredited medical school and completion of a residency program.
Unrestricted, current, active license to practice medicine issued by the New York State Board of Licensure or the State Board of Osteopathic Examiners.
Membership in good standing in the medical community.
Five years of post-graduate clinical experience in health care management and utilization review.
Excellent verbal, written, and interpersonal communication skills.
Solid computer navigational skills.
Demonstrated ability to work effectively as a member of a multidisciplinary team.
Demonstrated ability to analyze, interpret, and communicate the significance of health care data.
Ability to rotate in the UM call schedule to remotely cover evenings, weekends, and holidays.
Demonstrated examples of the Independent Health values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Nice To Haves

Master’s degree in healthcare administration, business, or public health.
Board certification in an ABMS-recognized medical specialty, preferably primary care such as internal medicine or family practice.
Experience in quality assurance and peer review.
Private practice experience.

Responsibilities

Ensure UM decisions are consistent with member contract terms.
Ensure UM decisions concern services that are medically necessary.
Ensure UM decisions comply with approved Independent Health and regulatory policies.
Ensure appropriate information is available to determine medical necessity for approved services.
Ensure reviews are completed within regulatory time frames.
Work with UM leadership to ensure accuracy, consistency, and efficiency of the UM process.
Assist UM leadership in developing performance reporting.
Collaborate with internal teams to support corporate HEDIS initiatives.
Support UM leadership in improving clinical service operations.
Serve on Independent Health committees as appropriate or as designated by the Medical Director.
Assist the Medical Director with oversight, development, and maintenance of UM programs.
Support preparation of annual UM program metrics and contribute to measurable outcomes for prior authorization, step therapy, and quantity limit programs.