Associate Medical Director - UM

IHA Independent Health Association, Inc.; United States; Hybrid; USD 250,000 - 300,000; Full time

Benefits offered by this job

Scorecard incentive

Full benefits package

Generous paid time off

Job summary

Independent Health seeks an Associate Medical Director, Utilization Management, to assist the Medical Director in overseeing UM programs, ensuring clinical accuracy and efficiency across prior authorization, step therapy, and quantity limit initiatives.

The role supports corporate direction for UM, develops performance reporting, and collaborates with cross-functional teams. Hybrid on-site work in Williamsville NY is required, with competitive compensation and a broad benefits package.

Qualifications

• Graduate Degree required from an accredited medical school and residency program.
• Master’s degree in healthcare administration, business, or public health preferred.
• Unrestricted, current medical license in NY State or equivalent.
• Board certification in a recognized specialty (ABMS), preferably primary care.

Responsibilities

• Assist Medical Director in oversight of Utilization Management (UM) programs.
• Develop strategic direction/focus for UM programs.
• Prepare annual UM metrics with SVP, Healthcare Services.
• Support HEDIS initiatives and clinical program development.
• Collaborate with internal teams to ensure medical necessity reviews are timely and accurate.
• Serve on IH committees as directed.

Skills

Utilization Management

Clinical leadership

Data interpretation

Interdisciplinary collaboration

Healthcare policy

Education

MD/DO with residency

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

Tools

EMR systems

Job description

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.

Overview

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.

Qualifications

• Graduate 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 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.

his is a hybrid position with onsite attendance required at our Williamsville location.

Hiring Compensation Range: $250,000 - $300,000 annually 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
• generous paid time off

The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / AAP 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.

Current Associates must apply internally via the Job Hub.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans.

An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: [e-mail] or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.

Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community. We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog. We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more.