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About the Role
The Associate Medical Director, Utilization Management assists the Medical Director in overseeing Utilization Management (UM) programs, focusing on clinical accuracy and appropriateness. This role supports the development of strategic corporate direction for UM programs and contributes to the provision of measurable outcomes for various clinical programs.
Responsibilities
- Assist the Medical Director in the oversight of Utilization Management (UM) programs.
- Support the development and maintenance of UM programs with a focus 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 UM program results.
- Contribute to the provision of 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.
- Provide clinical guidance and oversight to clinical program development teams, clinical service operations, and clinical quality committees.
- Serve on IH committees as directed by the Medical Director.
- Ensure UM decisions are consistent with member contracts, medical necessity, and approved policies.
- Ensure appropriate information is available to determine medical necessity.
- Ensure reviews are completed within regulatory time frames.
- Work with UM leadership to ensure accuracy, consistency, and efficiency of the UM process.
- Assist UM leadership in the development of performance reporting.
- Support UM leadership to improve clinical service operations.
- Serve on Independent Health committees as appropriate or as designated by Medical Director.
Requirements
- Graduate Degree required from an accredited medical school and residency program.
- 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 the significance of health care data.
- Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.
Skills
- Clinical accuracy
- Clinical appropriateness
- HEDIS initiatives
- Clinical program development
- Clinical service operations
- Clinical quality committees
- Medical necessity determination
- Performance reporting
- Verbal communication
- Written communication
- Interpersonal communication
- Computer navigation
- Teamwork
- Data analysis
- Data interpretation
- Data communication
Location
- Williamsville
Work Type
- Hybrid
- Remote (for call schedule)
Experience Level
- Associate
- 5 years post-graduate clinical experience
Education Level
- Graduate Degree from accredited medical school and residency
- Master’s degree in healthcare administration, business, or public health preferred
- Board certified in a recognized medical specialty
Salary/Compensations
- $250,000 - $300,000 annually
Benefits
- First-class perks
- Full range of benefits
- Generous paid time off
- Scorecard incentive
About the Company
- We're excited about the potential people bring to our organization.
- You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
Equal Opportunity
- As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
- Click here for additional EEO/AAP or Reasonable Accommodation information.