Associate Medical Director - UM PT

About the role

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

• 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.
• Five (5) years of post-graduate clinical experience in health care management and utilization review required; quality assurance and peer review experience preferred.
• Private practice experience preferred.
• Ability to rotate in UM call schedule to remotely cover evenings, weekends and holidays.
• 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.
• Essential Accountabilities
• 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.
• Immigration or work visa sponsorship will not be provided for this position
• Hiring Compensation Range: $115.00 - $155.00 hourly
• Compensation may vary based on factors including but not limited to skills, education, location and experience.
• In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
• Current Associates must apply internally via the Job Hub app.

Benefits

Additional Information

FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. *** Will consider applicants from NY, FL, NC, SC, TX ***

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