Associate Medical Director, Utilization Management — Hybrid

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

Job summary

Independent Health is seeking an Associate Medical Director, Utilization Management to assist the Medical Director in overseeing UM programs and developing strategic direction focused on clinical accuracy and program effectiveness. The AMD will collaborate with internal teams and contribute to HEDIS initiatives and performance reporting.

The role is hybrid with onsite attendance at Williamsville, NY. Requires board certification, NY license, and 5 years of post-graduate clinical experience in

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, NY State Board of Licensure or State Board of Osteopathic Examiners.
• Board certified in a recognized medical specialty by ABMS, preferably Primary Care.
• Five (5) years of post-graduate clinical experience in health care management and utilization review required.
• 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 IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

Responsibilities

• Ensure that all UM decisions are consistent with member contracts.
• Ensure all UM decisions represent medically necessary services.
• Ensure UM decisions comply with IH and regulatory policies.
• Provide information to determine medical necessity for approved services.
• Ensure reviews are completed within regulatory time frames.
• Collaborate with UM leadership to improve accuracy, consistency, and efficiency of the UM process.
• Assist UM leadership in developing performance reporting.
• Support corporate HEDIS initiatives with internal teams.
• Support UM leadership to improve clinical service operations.
• Serve on IH committees as directed by Medical Director.

Job description

Independent Health is seeking an Associate Medical Director, Utilization Management to assist the Medical Director in overseeing UM programs and developing strategic direction focused on clinical accuracy and program effectiveness. The AMD will collaborate with internal teams and contribute to HEDIS initiatives and performance reporting.

The role is hybrid with onsite attendance at Williamsville, NY. Requires board certification, NY license, and 5 years of post-graduate clinical experience in