The Associate Medical Director assists the CMO in the clinical leadership and oversight of the Quality Management (QM)/Medical Informatics units and assists the CMO in the clinical oversight of the Health Services Department. The position is responsible for ensuring implementation of Amida Care’s medical and quality management programs in compliance with New York State Department of Health (SDOH) and Center’s for Medicare and Medicaid Services (CMS) regulations and standards of care. The Associate Medical Director helps shape company-wide clinical strategies to ensure that company standards and practices are the best achievable in the marketplace.
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.
• Assists the CMO in providing clinical leadership to Utilization Management, Care Coordination and QM/Medical Informatics units, in collaboration with.
• Provide medical expertise to the Quality Management Committee and oversees the analysis and reporting of Medical Management and Quality Management activities to internal committees, the Board of Directors, and regulatory partners.
• Oversee with the Quality Director the annual HEDIS submission in collaboration with QM and the Information Systems Dept.
• Contribute to and collaborate as part of the Health Services executive team on action plans and tactics to implement strategic initiatives, to address areas of concern and monitor progress toward goals.
• Consult with providers on referrals, denials and complaints as needed.
• Assist in formulation of medical management and quality policies and guidelines. Provide clinical leadership to the administration of these policies and ensure they are reflected in electronic systems and understood by affected departments.
• Help oversee Medical (Utilization) Management Program and sub-contractors performing aspects of that program.
• Participate as a member of Interdisciplinary Care Teams (ICT) that ensures an integrated model of care approach for the designated population(s). Work with other medical representatives of ICTs to ensure a consistent and high value approach to team processes.
Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis.
• Conduct reviews of care related to sentinel events, quality issues or other problems/concerns identified by Plan staff, providers or delegated utilization review agents' staff.
• Co-chair, with the Medical Management Director, the Medicaid Clinical Subcommittee and Credentialing Committee; direct and monitor the functions of the Subcommittee as defined in the Amida Care Quality Management Program.
• Provide oversight of Medicaid authorization and appeals processes.
• Collaborate with leadership of Behavioral Health, Community Based Services and Outreach units to ensure coordination of efforts to achieve best outcomes for patients.
• Represent organization externally, i.e., community events, regulatory meetings, etc. when feasible to.
MINIMUM JOB REQUIREMENTS
Amida Care is a Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equality and leverages diversity and inclusiveness in all that we do.
• MD preferred. NP or similar degrees that provide the experience and background needed for this work will be considered
• Minimum of Five (5) years’ experience in a Medicaid managed care area
• Demonstrated advanced knowledge and understanding of government regulations (Medicaid)
• Strong business acumen, including working knowledge of changing U.S. payer and provider landscape
• Demonstrated understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.