Part-Time Associate Medical Director for UM
About the Opportunity
A healthcare organization is actively seeking an experienced medical professional to join their staff as the Associate Medical Director for UM on a part-time basis. The qualified Associate Medical Director selected for this role will be responsible for ensuring the effective utilization of medical services through the application of nationally recognized medical necessity criteria.
The Associate Medical Director for UM will be responsible for:
- Making Medical Necessity determinations and conducting utilization reviews and overall quality evaluations of requested medical and surgical services and hospital stays including concurrent and prospective inpatient stays.
- Using available data and chart reviews
- Performing the functions of pre-authorization, pre-admission, admission, continued stay, discharge, and re-admission reviews and quality reviews against standard supplied review criteria and the organization's coverage guidelines
- Documenting review determination in the Acuity system
- Consulting with requesting/referring physicians as deemed necessary by reviewer or when reconsideration is requested; consults with other organization staff or vendors
- Assisting with the coordination of the appeal process for denied services, including making appeal determinations
- Attending monthly Quality Improvement Committee meeting (QIC) and other staff meetings
- Working onsite five days a week or four days a week which must include Fridays.
- Performing other duties as assigned
- 5+ years of Utilization Review experience
- NYS MD license
- Board Certified in: Internal Medicine, Pediatrics, Family Practice, General Surgery or OB-GYN
- Experience managing a group
- Effective communication skills
- Detail oriented
- Highly organized
- Managed Care Organization experience
- UR experience