Associate Medical Director - UM PT
WFA Digital Insight
In the current remote job market, medical directors with expertise in utilization management are in high demand. With the rise of value-based care, the demand for professionals who can balance clinical decision-making with business acumen has grown significantly, with some estimates suggesting a 25% increase in job openings over the past two years. Independent Health stands out for its commitment to innovation and collaboration, making this role an attractive opportunity for those who want to drive meaningful change in the healthcare industry. Candidates should be aware that this role requires strong clinical and communication skills, as well as the ability to work effectively in a remote team environment.
Job Description
About the Role
The Associate Medical Director, Utilization Management plays a critical role in overseeing the development and maintenance of utilization management programs at Independent Health. This involves collaborating with internal teams to support corporate HEDIS initiatives and providing clinical guidance and oversight to ensure that all utilization management decisions are consistent with the terms of member contracts and represent medically necessary services. The successful candidate will work closely with the Medical Director and other stakeholders to develop strategic corporate direction and focus for utilization management programs.As a key member of the utilization management team, the Associate Medical Director will be responsible for analyzing and interpreting healthcare data to inform decision-making and drive improvements in clinical service operations. This will involve working with the UM leadership to ensure accuracy, consistency, and efficiency of the UM process, as well as assisting in the development of performance reporting and collaborating with internal teams to support corporate HEDIS initiatives.
The Associate Medical Director will also serve on Independent Health committees as directed by the Medical Director, providing clinical expertise and guidance to support the development of clinically effective and efficient utilization management programs.
What You Will Do
- Assist the Medical Director in the oversight of Utilization Management programs
- Support the development and maintenance of UM programs, with a focus on clinical accuracy and appropriateness
- Collaborate with internal teams to support corporate HEDIS initiatives
- Provide clinical guidance and oversight to clinical program development teams, clinical service operations, and clinical quality committees
- Contribute to the provision of measurable outcomes for prior authorization, step therapy, and quantity limit programs
- Work with the UM leadership to ensure accuracy, consistency, and efficiency of the UM process
- Assist in the development of performance reporting
- Collaborate with internal teams to support corporate HEDIS initiatives
- Serve on Independent Health committees as directed by the Medical Director
- Rotate in UM call schedule to remotely cover evenings, weekends, and holidays
What We Are Looking For
- Graduate Degree from an accredited medical school and residency program
- Unrestricted, current, active license to practice medicine, issued by the NY State Board of Licensure or the State Board of Osteopathic Examiners
- Board certification in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS)
- Five years of post-graduate clinical experience in healthcare management and utilization review
- Excellent verbal, written, and interpersonal communication skills
- Solid computer navigational skills
- Ability to work effectively as a member of a multi-disciplinary team
- Ability to analyze, interpret, and communicate the significance of healthcare data
Nice to Have
- Master’s degree in healthcare administration, business, or public health
- Private practice experience
- Quality assurance and peer review experience
- Experience with Excel and other data analysis tools
Benefits and Perks
- Competitive hourly rate
- Scorecard incentive
- Full range of benefits, including health, dental, and vision insurance
- Generous paid time off
- Remote work stipend
- Opportunities for professional development and growth
- Collaborative and dynamic work environment
How to Stand Out
- Make sure to highlight your experience with utilization management programs and clinical decision-making in your application
- Develop a strong understanding of the company’s values and mission, and be prepared to discuss how your skills and experience align with these
- Practice your communication skills, as the ability to effectively communicate with internal teams and stakeholders is critical in this role
- Be prepared to provide specific examples of your experience with data analysis and interpretation, and how you have used this to drive improvements in clinical service operations
- Consider reaching out to current or former employees to gain insight into the company culture and what it’s like to work in this role
- Tailor your resume and cover letter to the specific requirements of the job, and make sure to include any relevant certifications or licenses
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