Associate Medical Director

University Medical Center of El Paso (UMC) is in search of a dynamic physician leader to fill the Associate Medical Director (Associate Director) position at El Paso Health , a local, non-profit health plan serving El Paso and Hudspeth counties. The Associate Director is responsible for providing physician support for all clinical, quality and utilization management activities of the Health Plan and is responsible for day-to-day medical administration and provides guidance for the clinical operational aspects of organization’s programs. The Associate Director carries on with the responsibilities of the Health Plan’s Medical Director in the event of the Medical Director’s absence. Experience/Education/Licensing Requirements Five years of post-graduate clinical experience in direct patient care within the areas of Family Practice, Pediatrics or Internal Medicine. Two years of experience in a Managed Care Organization preferred. Doctorate of Medicine or Osteopathy required. Current, valid and unrestricted license to practice medicine as a doctor of medicine (MD) or a doctor of osteopathic medicine (DO) in the state of Texas. Board certification through the American Board of Medical Specialties or the Advisory Board Osteopathic Specialists. Available at all times to address complaints, clinical issues, clinical peer review, utilization review and any quality of care issues on behalf of the Health Plan. Available to non-clinical administrative Associates during initial screening of authorizations and engages in consultation with utilization management Associates who conduct the initial clinical review. Assists in determining if contracted or employed peer reviewers are qualified, to render a clinical opinion about the medical condition, procedures, and treatment under review. Available to conduct peer-to-peer conversations with the attending Physician or other ordering Physician for cases where a certification is not issued during the initial clinical review. Engages in peer-to-peer conversation as an alternate peer reviewer, if the original peer reviewer is unavailable. Monitors and reviews practice patterns of contracted providers. Serves as final decision-maker on decisions of medical necessity and medical appropriateness. Conducts medical, behavioral health, and drug utilization appeals, including appeal of prior authorization denials for outpatient pharmacy benefits within the required time frames while in a state or territory of the United States. Assists in leading cost containment activities as directed by the Medical Director. Provides medical direction as a member of El Paso Health committees. Functions as a resource to Senior Management on Quality Assurance and Quality Improvement issues and initiatives. Participates in the development of departmental and organizational policies and procedures. Promotes a service orientation in the performance of position duties and responsibilities and in interactions with patients, hospital staff and visitors. Collaboration and Accountabilities Coordination of physician-to-physician communications with respect to clinical protocols and clinical peer reviews. When conducting clinical peer review, the Associate Medical Director will be located in a state or territory of the United States unless expressly allowed by state or federal law or regulation. Responsible for all clinical aspects of the Credentialing Program in the absence of the Medical Director. The Associate Medical Director will be subject to the Health Plan’s credentialing requirements. Utilization management to include prospective, concurrent, and retrospective case review. Quality Management to include review of clinical data to improve the quality of patient care. Assist in the oversight of medical arrangement operations to ensure successful health delivery services. Evaluates new technologies and treatments and recommends preferred protocols. Ensures that qualified clinicians are accountable to the organization for decisions affecting consumers. Benefits Robust benefits including medical, prescription, dental, vision and life insurances. Eligibility to participate in the Texas County/District Retirement System (Defined Pension Plan) 403(b) and 457 Retirement Plans Generous PTO Education Loan Dismissal Program CARES Student Loan Repayment Program CARES Home Ownership Program Dynamic teaching environment Relocation Reimbursement Assistance and more! Submit resume to: Art Macias, Director-Recruitment via email at View email address on click.appcast.io or apply directly at: #J-18808-Ljbffr University Medical Center of El Paso (UMC)