Associate Medical Director – UM PT
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Job Description
Associate Medical Director ensuring clinical accuracy and oversight of UM programs at Independent Health. Collaborating with teams to support clinical program development and HEDIS initiatives.
Responsibilities:
- Responsible for assisting the Medical Director in the oversight of Utilization Management (UM) programs
- Support the development and maintenance of these programs, focusing on clinical accuracy and appropriateness
- Assist the Medical Director in developing strategic corporate direction for UM programs
- Support the SVP, Healthcare Services in preparing annual metrics of results for UM programs
- Contribute to measurable outcomes for prior authorization, step therapy, and quantity limit programs
- Collaborate with internal teams to support corporate HEDIS initiatives with appropriate clinical program development
- Work closely with clinical program development teams, clinical service operations, and clinical quality committees
- Provide clinical guidance and oversight to these areas
- Serve on IH committees as directed by the Medical Director
Requirements:
- 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.
Benefits:
- Full range of benefits
- Generous paid time off
- Scorecard incentive
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