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

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.

Associate Medical Director – UM PT

Key skills