American Specialty Health Incorporated is seeking an Associate Medical Director - Health Services to join our Health Services department. This position will provide medical decision making for Rehabilitation Services and other Service Lines (chiropractic, acupuncture, other) 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.

Remote Worker Considerations:

Candidates who are selected for 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 remote/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 (minimum internet download of 50 Mbps and 10 Mbps upload speed).

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 RQE 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.
• 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.

Qualifications

• Graduate of an accredited medical college in the US and Board certified (Required).
• 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).
• Experience in musculoskeletal medicine and/or Physical Therapy knowledge (Required).
• All clinical credentials are active and good standing with State Board (Required).
• At least 5 years of Clinical practice experience (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.
• 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's mission, vision, and corporate goals to improve quality and efficiency of health care delivery.
• 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.

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 extended periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and outside the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs. Ability to travel within the U.S. as required at least 30% of time.

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 race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local 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.