Strategic Associate Medical Director, Utilization Management

Independent Health; United States; Hybrid; USD 250,000 - 300,000; Full time

Benefits offered by this job

Generous paid time off

Scorecard incentive program

Comprehensive benefits

Job summary

Independent Health is seeking an Associate Medical Director to assist the Medical Director in overseeing Utilization Management programs, focusing on clinical accuracy and program development. You will support metrics, prior authorization, step therapy, and quantity limit initiatives while collaborating with cross-functional teams.

The role requires board certification and a medical license in NY, with 5 years of post-graduate clinical experience in health care management.

Qualifications

• MD degree from an accredited medical school with residency
• Active medical license in NY
• Board certification in primary care preferred
• 5 years post-graduate clinical experience in health care management and utilization review
• Private practice experience preferred
• Ability to rotate UM call schedule to remotely cover evenings, weekends and holidays
• Excellent verbal, written and interpersonal communication skills
• Solid computer navigational skills

Responsibilities

• Ensure UM decisions are consistent with member contracts and medically necessary
• Maintain compliance with IH policies and regulatory requirements
• Provide information to determine medical necessity for approved services
• Complete reviews within regulatory time frames
• Collaborate with UM leadership on performance reporting
• Contribute to corporate HEDIS initiatives
• Support UM leadership to improve clinical service operations
• Serve on IH committees as directed by Medical Director

Skills

Medical license

Board certification

Healthcare management

Utilization review

Data analysis

Communication

Education

MD degree

MS/MPH in health admin

Medical license NY

Job description

Independent Health is seeking an Associate Medical Director to assist the Medical Director in overseeing Utilization Management programs, focusing on clinical accuracy and program development. You will support metrics, prior authorization, step therapy, and quantity limit initiatives while collaborating with cross-functional teams.

The role requires board certification and a medical license in NY, with 5 years of post-graduate clinical experience in health care management.