Associate Medical Director-Health Services UM & Virtual Support (Remote, Part-Time Position)

American Specialty Health Incorporated (ASH) is seeking an Associate Medical Director - Health Services UM and Virtual Support to join our Health Services department.

The primary purpose of this position is to provide medical decision making for Rehabilitation Services and other Service Lines (chiropractic, acupuncture, other) as well as providing virtual telehealth medical support, and other ASH functions as required by position responsibilities in collaboration with ASH Sr Medical Directors, Chief Health Services Officer, and other clinical and operational leadership.

Salary Range

American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $90 to $110 Part-Time Hourly Salary Range.

Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

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.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

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