Associate Medical Director - UM

Independent Health; Buffalo (NY); Hybrid; USD 250,000 - 300,000; Full time

Benefits offered by this job

Hybrid work schedule

Competitive compensation and benefits

Job summary

Independent Health seeks an Associate Medical Director, Utilization Management to assist the Medical Director in overseeing UM programs and ensuring clinical accuracy and appropriateness. The role supports annual metrics, prior authorization, step therapy, and quantity limit programs.

The AMD will collaborate with clinical program development teams, submit to IH committees as directed, and rotate UM call coverage including evenings and weekends.

Qualifications

• Graduate degree from an accredited medical school and residency program required.
• Unrestricted medical license to practice medicine in NY.
• Board Certification by ABMS, preferably in Primary Care.
• Five years of post-graduate clinical experience in health care management and utilization review.
• Private practice experience preferred.
• Ability to rotate in UM call schedule (evenings, weekends, holidays).

Responsibilities

• Ensure UM decisions are medically necessary and within member contracts.
• Ensure UM decisions align with IH policies and regulatory requirements.
• Provide information to determine medical necessity for approved services.
• Complete reviews within regulatory time frames.
• Develop and report performance metrics for UM programs.
• Collaborate with internal teams on HEDIS initiatives.
• Support UM leadership to improve clinical service operations.
• Serve on IH committees as directed by Medical Director.

Skills

Clinical leadership

Verbal and written communication

Analytical thinking

Team collaboration

Education

MD/DO degree

Residency program completed

Master’s degree preferred (healthcare admin/public health)

Tools

Computer literacy

Job description

FIND YOUR FUTUREWe'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.OverviewThe 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.QualificationsGraduate Degree required from an accredited medical school and residency program required. Master’s degree in healthcare administration, business, or public health preferred. 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.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 AccountabilitiesEnsure 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.his is a hybrid position with onsite attendance required at our Williamsville location.Immigration or work visa sponsorship will not be provided for this positionHiring Compensation Range: $250,000 - $300,000 annuallyCompensation 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.As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.Current Associates must apply internally via the Job Hub.