Medical Director Job at Community Health Choice, Houston, TX

enM0bHZCL0MzSDVRNDhuT3hjR0ZCMUN1QlE9PQ==
  • Community Health Choice
  • Houston, TX

Job Description

About the Role:

Medical Director plays a critical role in assuring that the Utilization Management (UM) program is running well, is focusing on the highest value opportunities and has an effective prior authorization program and Medical Review Guidelines (MRG). The Medical Director is a leadership role within the Medical Director Group and has the ability to positively influence the Associate Medical Directors. The Medical Director reports to the Senior Medical Director and works with him/her collaboratively to ensure the Prior Authorization and concurrent reviews are done efficiently and effectively and are evidence-based. In addition, the Medical Director will work on committees and projects as assigned and will be able to advise on coding issues and medical necessity as requested.

Responsibilities:

  • Board certified physician and licensed in Texas required.
  • Primary Care Specialties preferred.
  • 5-7 years in active practice required.
  • Prior managed care experience preferred.
  • Has minimum of 4 years of experience in utilization management (UM), and medical policy development.
  • Coding expertise and experience in managing network physicians.
  • Proficient in office software; must be able to become proficient in clinical information systems.
  • Prior experience with clinical information systems such as Jiva; experience with data analysis.

Required Skills:

  • Education/Specialized Training/Licensure: Board certified physician and licensed in Texas required. Primary Care Specialties preferred
  • Work Experience (Years and Area): 5-7 years in active practice required. Prior managed care experience preferred.
  • Management Experience (Years and Area): Has minimum of 4 years of experience in utilization management (UM), and medical policy development.
  • Coding expertise and experience in managing network physicians. Software Proficiencies:
  • Proficient in office software; must be able to become proficient in clinical information systems. Prior experience with clinical information systems such as Jiva; experience with data analysis.

Equal Opportunity Statement:

Include a statement on commitment to diversity and inclusivity.

Job Tags

Work experience placement,

Similar Jobs

Circle Home Telehealth Services

Director of Physician Engagement Job at Circle Home Telehealth Services

 ...Medicare) living at home to better manage their care so they can minimize or avoid breakdowns...  ...a highly specialized, multi-state physician group practice specializing in remote chronic...  ...home. In-depth working knowledge of primary care office operations and a firsthand... 

Stelvio Group

Warehouse Manager Job at Stelvio Group

 ...Dental insurance ~ Employee discount ~ Health insurance ~ Paid time off ~ Professional development assistance ~ Referral program ~ Tuition reimbursement ~ Vision insurance Schedule: ~8-hour shift ~ Monday to Friday ~ Weekends as needed... 

Dropoff, Inc.

Cargo Van Driver For Delivery Route in Buffalo Job at Dropoff, Inc.

 ...Company Overview Dropoff is a same-day, last mile delivery service that enables businesses across industries to meet rising expectations...  ...knowledge of the city ~ A registered, insured and inspectedvan less than 10 years old ~ A current driving license and clean driving... 

Carney, Sandoe & Associates

Spanish and Latin Teacher Job at Carney, Sandoe & Associates

 ...Carney, Sandoe & Associates, an education recruitment firm, is currently seeking a Spanish & Latin Teacher for the 2025-2026 school year at an independent school in the San Antonio area. About CS&A: Our free job placement service connects educators with independent... 

NJASAP

Graphic Designer Job at NJASAP

Position Summary As the NJASAP Graphic Designer, you will play a critical role in shaping how the Union communicates with its members, their families, our airline labor partners, the media and public. You will be responsible for creating impactful visuals that advance...