[Hiring] Associate Medical Director @Acentra Health, LLC

Role Description

The Associate Medical Director will engage in medical activities such as:

• Peer review of medical prior authorizations
• Peer-to-peer conversations
• Testimony on behalf of Health First Colorado during Medicaid Fair Hearings
• Other clinical consultations related to the applicable contract

This is a part-time position (~20 hours per week).

• Responsible for day-to-day clinical decision-making aspects of the Utilization Management program and provides clinical guidance to clinical review team members.
• Collaborate with other Medical Directors on case consultations as needed.
• Discuss complicated Utilization Management reviews or clinical scenarios with Utilization Management Clinical Reviewers.
• Participate in the client's weekly, monthly, quarterly, and ad-hoc medical meetings.
• Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy.
• Conduct educational meetings twice a year for Clinical Review staff on relevant clinical topics of interest.
• Complete secondary-level Utilization Management reviews including peer-to-peer and reconsideration UM reviews.
• Prepare for and attend by video conference assigned Medicaid Fair Hearings defending the determinations made by the Company on behalf of Health First Colorado.
• Participate in annual and ad hoc review of clinical medical necessity criteria consistent with clinical expertise.
• Perform any other duties assigned.

Qualifications

• M.D. or D.O. with a current non-restricted license to practice medicine by the Board of Medical Examiners.
• Board certification in a clinical specialty is required.
• 10+ years of active practice preferred; 5 years minimum required.
• 5-7 years of experience in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.
• Experience in Utilization Management with knowledge of Medicaid and Medicare programs.
• Exceptional writing and oral communication abilities.
• Strong knowledge of quality assurance and utilization review.

Requirements

• 2 years as a Medical Director in a managed care company or health plan preferred.
• Prior review experience or quality assurance committee responsibility in a hospital setting is preferred.
• Proficient in Microsoft Excel and other Microsoft Office applications.
• Understand significant trends in healthcare and managed care.
• Ability to work effectively with a diversity of personalities.
• Ability to be approachable, show respect for others, and be a consensus builder.
• Strong organizational skills and a system thinking approach.
• Ability to efficiently manage projects.
• Ability to deliver on time and within budget.
• Adaptable with a collaborative solid management style.
• Ability to be a creative thinker.
• Possess high energy and enthusiasm.
• Able to adapt to frequently changing work parameters.

Pay Range

USD $187,520.00 - USD $90.15 /Hr.