Associate Medical Director

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Associate Medical Director-Health Services UM & Virtual Support based in the United States.

• Make medical management and utilization management decisions within the assigned scope of authority, consistent with applicable state regulations, delegation requirements, appeals processes, and client expectations.
• Provide medical decision-making support for rehabilitation services and other assigned service lines, including physical therapy, occupational therapy, speech therapy, athletic training, chiropractic, and acupuncture.
• Conduct medical necessity reviews and utilization reviews while maintaining appropriate quality, accuracy, productivity, and turnaround times.
• Support delegated appeals processes through clinical review and medical decision-making.
• Provide clinical guidance and support to Clinical Quality and Evaluation team members for training, auditing, quality initiatives, and other assigned projects.
• Participate in utilization management activities and file reviews as needed to address workload, turnaround-time requirements, staffing needs, planned absences, and other operational priorities.
• Provide virtual telehealth medical consultation and clinical support for designated virtual healthcare programs.
• Collaborate with senior medical directors, the Chief Health Services Officer, and other clinical and operational leaders on medical management activities and special initiatives.
• Serve as backup support for medical necessity review activities and other medical director functions when required.
• Contribute to the development and application of clinical policies, guidelines, quality standards, and medical necessity criteria.
• Attend clinical committee meetings and contribute to clinical quality management and organizational healthcare initiatives.
• Apply for, obtain, and maintain medical licenses in additional states as required for the role.
• Foster effective teamwork, communication, and organizational efficiency across clinical and operational teams.
• Maintain compliance with all applicable organizational policies, procedures, standards, regulatory requirements, and confidentiality expectations.
• Perform additional duties and special projects as assigned.

• Graduate of an accredited medical college in the United States.
• Board certification is required.
• Minimum of 5 years of clinical practice experience.
• Current, unrestricted medical or osteopathic license in the United States, with the ability and willingness to obtain and maintain additional state medical licenses as required.
• All clinical credentials must remain active and in good standing with the applicable state medical boards.
• Demonstrated experience in utilization management and medical necessity review.
• Experience conducting provider discussions related to utilization management and medical necessity decisions.
• Experience in clinical quality assurance and/or quality management.
• Strong knowledge of musculoskeletal medicine and/or physical therapy.
• Ability to make sound clinical decisions and provide guidance to staff involved in credentialing, medical necessity review, utilization management, quality assurance, quality improvement, and medical necessity verification.
• Ability to research clinical information, validate relevant evidence, and apply findings appropriately to medical and operational decisions.
• Ability to provide telehealth medical consultation and clinical support for virtual healthcare programs.
• Ability to understand, develop, and apply clinical policies and guidelines supporting clinical staff and healthcare decision-making.
• Experience as a medical director within a full-service health plan or insurance organization is preferred.
• Familiarity with complementary healthcare services is preferred.
• Strong computer skills and confidence working with technology-enabled healthcare and remote-work environments.
• Excellent analytical, problem-solving, organizational, and decision-making skills.
• Strong listening, interpersonal, and written and verbal communication skills.
• Demonstrated ability to establish positive, respectful, and cooperative relationships with internal and external stakeholders.
• Ability to organize, prioritize, multitask, and manage time effectively in a changing environment with frequent interruptions.
• Strong attention to accuracy and productivity while managing competing priorities.
• Ability to handle confidential information with discretion and maintain strict confidentiality.
• Primarily sedentary work requiring the ability to sit, stand, and use a computer for extended periods.