Associate Medical Director-Health Services

Job Description

Responsibilities

• Responsible for all activities within assigned scope of authority.
  • Accountable for all activities within assigned scope of authority. Ensures accuracy and productivity in project development and completion; works cooperatively with all internal and external contacts.
  • Responsible for making medical management UM decisions as required by State regulation, delegation, appeals, or client requirements.
  • Responsible for medical decision making in support of delegated ASH Appeals Processes.
  • Support to CQE team members in support of training, auditing, and other projects.
  • Responsible for the day-to-day activities that produce the quality, efficiency and effectiveness of the medical decision making for medical necessity review of Physical Therapy, Occupational Therapy, Speech Therapy and Athletic Training, Chiropractic and Acupuncture utilization review and quality management programs.
  • Supports utilization management activities as directed, including file review as needed based on report quantity, turnaround time constraints, PTO, and other potential issues that may arise.
  • Provide virtual telehealth medical support as requested.
  • Apply for and maintain clinical licenses in states as requested.
  • Support other medical directors in MNR back up and CHSO and Health Services for special projects.
  • Attends clinical committee meetings in support of clinical activities of the clinical quality management processes of ASH.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Graduate of an accredited medical college in the US and Board certified required.
• 5 years of Clinical practice experience required.
• Experience in musculoskeletal medicine and/or Physical Therapy knowledge required.
• Experience as medical director for a full-service medical health plan / insurance company preferred.
• Experience in Utilization Management (UM) / Medical Necessity Review required.
• Experience in provider discussions related to UM decisions required.
• Experience Clinical Quality Assurance/ Quality Management required.
• General understanding of aspects of Complementary Health Care preferred.
• Ability to provide clinical decision-making and support to staff in support of credentialing, medical necessity review (Utilization Review/Utilization Management) quality assurance, quality improvement, and medical necessity verification activities.
• Ability to find clinical information, validate the information, and apply clinical information to clinical decisions in the context of ASH mission and vision and corporate goal to improve quality and efficiency of health care delivery.
• Ability to deliver Telehealth Medical Consultation in support of ASH Virtual programs as requested.
• Ability to apply for and maintain clinical licenses in states as requested.
• Ability to foster an environment of teamwork and organizational efficiency.
• Ability to understand and develop clinical policy and guidelines in support of clinical staff.
• Excellent computer skills.
• Must have a current, unrestricted medical or osteopathic license in the United States and be able to obtain, and willing and able to maintain, state medical licenses in other states as requested by company required.
• All clinical credentials are active and in good standing with State Board are required.

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