Associate Medical Director, Utilization Management (Hybrid)

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

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.