Associate Medical Director
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 access to 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.
The Associate Medical Director provides leadership and oversight of the Quality Management (QM)/Medical Informatics units and assists the CMO in the clinical oversight of the Health Services Department. As the lead in the Quality program this person is responsible for monitoring and evaluating access to quality health care that is driven by data analytics to ensure delivery of appropriate and equitable health care services to Amida Care members. The position is responsible for ensuring implementation of Amida Care’s medical and quality management programs in compliance with New York State Department of Health (SDOH) and Center’s for Medicare and Medicaid Services (CMS) regulations and standards of care. The Associate Medical Director helps shape company-wide clinical strategies to ensure that company standards and practices are the best achievable in the marketplace.
• Provide clinical leadership to Utilization Management, Care Coordination and QM/Medical Informatics units, in collaboration with the CMO.
• Provide medical expertise to the Quality Management Committee and lead the analysis and reporting of Medical Management, population health, value based care, and Quality Management activities to internal committees, the Board of Directors, and regulatory partners.
• Maintain compliance with clinical quality regulatory requirements, including the development and reporting of QMP, PIP, CAP, special studies and Performance Improvement initiatives as needed.
• Manage the quality metrics portion of the Value Based Contracts including generation of performance reports, data collection and assimilation, and reporting of performance with providers on a quarterly basis. Support enhancement of the VBP programs to align with the NYSDOH requirements.
• Guide the Medical Informatics team towards development of a comprehensive reporting infrastructure to support all quality management projects and reporting/analytical needs for Health Services.
• Oversee the annual HEDIS submission in collaboration with Information Systems Dept.
• Contribute to and collaborate as part of the Health Services executive team on action plans and tactics to implement strategic initiatives, to address areas of concern and monitor progress toward goals.
• 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 reflected in electronic systems and understood by affected departments.
• Help oversee Medical (Utilization) Management Program and sub-contractors performing aspects of that program.
• Participate as a member of Interdisciplinary Care Teams (ICT) that ensures an integrated model of care approach for the designated population(s). Work with other medical representatives of ICTs to ensure a consistent and high value approach to team processes.
• Other duties as assigned.
Amida Care is an equal employment opportunity employer and we seek diverse candidates with the following qualifications:
• NPH, PA, MPH or similar degrees that provide the experience and background needed for this work
EXPERIENCES AND/OR SKILLS REQUIRED
• Five (5) years’ experience in a Medicaid managed care area.
• Advanced knowledge and understanding of government regulations (Medicaid)
• Strong business acumen, including working knowledge of changing U.S. payer and provider landscape.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Compliance with all organizational policies regarding ethical business practices.
• Collaborative management/leadership style that blends well with an integrated care team approach to patient centered care delivery.