Associate Medical Director

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

The Associate Medical Director will engage medical activities like peer review, of medical prior authorizations, peer-to-peer conversations, testimony on behalf of Health First Colorado during Medicaid Fair Hearings, and other clinical consultations related to the applicable contract. The Associate Medical Director may also support business development and strategic planning as needed.

• 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.

• 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.

• 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.
• Exceptional writing and oral communication abilities.
• Strong knowledge of quality assurance and utilization review.
• 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.

USD $90.15 - USD $112.69 /Hr.