Associate Medical Director, Utilization & Outcomes

Independent Health Association; United States; On-site; USD 158,424 - 213,528; Full time

Job summary

Independent Health Association seeks an Associate Medical Director, Utilization Management to assist the Medical Director in UM program oversight, focusing on clinical accuracy, appropriateness, and performance reporting.

The AMD will collaborate across teams to support corporate HEDIS initiatives, provide clinical guidance, and participate in committees, aiming to improve medical necessity reviews and overall UM effectiveness.

Qualifications

• Graduate Medical Degree and residency required.
• Active NY medical license (or Osteopathic Examiners).
• Board certification by ABMS; primary care preferred.
• Five years post-graduate clinical experience in health care management and utilization review.
• Private practice experience preferred.
• Ability to rotate UM call schedule evenings/weekends/holidays.
• Excellent verbal, written and interpersonal communication skills.
• Solid computer navigational skills.
• Ability to work effectively in a multi-disciplinary team.
• Ability to analyze, interpret and communicate health care data.
• Demonstrated IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, Accountable.

Responsibilities

• Ensure UM decisions are medically necessary and consistent with member contracts.
• 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.
• Collaborate with internal teams to support corporate HEDIS initiatives.
• Support UM leadership to improve clinical service operations and serve on IH committees as directed.

Skills

Communication

Teamwork

Data analysis

Computer skills

Education

Medical degree (MD)

Residency program completed

MS in Healthcare Admin/Business/Public Health (preferred)

Job description

Independent Health Association seeks an Associate Medical Director, Utilization Management to assist the Medical Director in UM program oversight, focusing on clinical accuracy, appropriateness, and performance reporting.

The AMD will collaborate across teams to support corporate HEDIS initiatives, provide clinical guidance, and participate in committees, aiming to improve medical necessity reviews and overall UM effectiveness.