Job Description

The Associate Medical Director supports healthcare initiatives in partnership with the Health Plan and MSO leaders with specific attention to medical management, quality initiatives, and clinical oversight.  Serves as a clinical advisor and educator to ensure clinical quality and efficacy of patient care.

 

Collaborates with Medical Directors, Chief Medical Officers, and MSO leadership to provide oversight of clinical programs to support and meet the utilization management and quality goals with accountability to achieve medical expense and quality performance targets.  Responsible for timely and accurate physician reviews of quality and utilization/medical management to include but not limited to:  prior authorization, concurrent review, acute and post-acute reviews, retrospective reviews, case management, appeals, judicial hearings, claims, pharmacy, quality of care, peer review, and credentialing.

 

Identify trends in patient treatment data to eliminate unnecessary services and care delivery settings to recommend alternatives if appropriate by analyzing clinical, quality, and financial data through collaboration with leadership teams.

 

Provides support as the clinical subject matter expert for medical policies, clinical programs, coverage benefits, regulatory or accreditation deliverables, and other tasks as assigned.  Supports other departments in a consultative role as requested.

 

Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision, and values of the organization.  Performs other position appropriate duties as required in a competent, professional, and courteous manner.



Qualifications

Qualifications:

Bachelor's degree required

MD or DO with an active, unrestricted state medical license required

Board certified in medical specialty required

Minimum of five (5) years of clinical practice experience required

Minimum of one (1) year of managed care experience strongly preferred

Proficiency with managed care environment with a philosophy of collaboration and team work

Excellent verbal and written communication skills with the ability to build consensus

Application Instructions

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