Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide accessto comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit Amidacareny.org for more information about the Amida Care culture.We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Associate Medical Director. Compensation will be commensurate with experience. Position Summary:The Associate Medical Director (AMD) assists the Medical Director (MD) in the clinical leadership and oversight of the Medical Management unit and the Utilization Management program. The position is responsible for ensuring implementation of Amida Care's medical management program in compliance with New York State Department of Health (SDOH) and Center's for Medicare and Medicaid Services (CMS) regulations and standards of care. Along with the Medical Director, the Associate Medical Director helps shape company-wide clinical strategies to ensure that company standards and practices are the best achievable in the marketplace. Responsibilities:
- Provides clinical and operational leadership and oversight to the High-Risk Care Coordination, Medical Management, Prenatal and Children's Health programs, including reviews of policies, programs' structure, goals and initiatives.
- Provide medical expertise to the Quality Management Committee and Medical Management and Quality Management activities to internal committees, the Board of Directors, and regulatory partners.
- Collaborate with the Quality Director and Director of Medical Management on Quality-of-Care concerns.
- Collaborates with the Health Services leadership team on action plans and tactics to implement strategic initiatives, addressing HIV Viral Load Suppression or other Quality management areas.
- 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 properly implemented.
- Communicate and provide support to network providers to ensure New York State Department of Health's guidelines are followed, specifically in the areas of HIV, Prenatal, and Pediatric care.
- Assist Medical Director in providing clinical leadership to the Utilization Management Program and delegated vendors performing aspects of that program.
- Assist Medical Director in Case Reviews and making determinations in compliance with NY SDOH clinical guidelines.
- Support Integrated Care Teams (ICT) to ensure a holistic model of care approach for Amida Care's members. Amida Care is 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 equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED
- MD with active NYS LicenseEXPERIENCES AND/OR SKILLS REQUIRED
- Minimum of Five (5) years' experience in Medicaid managed care area preferred. Applicants with experience in clinical setting (preferably with patients with HIV, pediatric patients) and no managed care experience may be considered.
- Experience working with patients with HIV, preferred. Experience in the areas of pediatrics, prenatal care, substance use disorder is a plus.
- 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 and beliefs, demonstrated appropriate behaviors in alignment with the organization's vision, mission, and values.