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

Guardian Angel Senior Services

Caregiver for senior citizens. Job at Guardian Angel Senior Services

 ...Are you someone who finds purpose in helping others? Do you want to make a real difference in the lives of senior citizens while forming meaningful connections? &##127775; If so, wed love to meet you! As a Heartfelt Companion & Caregiver , you will be a vital part... 

SMART CHOICE MEDICAL SERVICES LLC

Part-time Nurse Practitioner (Wound Care) Job at SMART CHOICE MEDICAL SERVICES LLC

 ...This is a part-time position that has the potential to grow to full-time. We are looking for someone to work 16 - 20 hours per week. We are seeking a compassionate and skilled Nurse Practitioner specializing in Wound Care to join our mobile healthcare team. The ideal... 

Kumon North America, Inc.

Videographer Job at Kumon North America, Inc.

 .... Whether you're capturing live events, producing polished internal videos, or shaping content for digital platforms, this role will give...  ...operate video, audio, and lighting equipment Post-Production : Edit event footage, internal videos, and presentations using Adobe... 

Mymdcareers

NP for Endocrinology Group Job at Mymdcareers

Private practice in Coral Gables area of Miami seeks Endocrinology NP as a result of growth. Must be experienced in Endo or Internal Medicine. Be ready to step into a busy practice. Base salary with benefits and bonus. For details call Michael at (***) ***-**** or michael... 

Scalo Inc

AutoCAD Technician Job at Scalo Inc

 ...Job Responsibilities: Scalo Inc is seeking an experienced AutoCAD Technician with a keen eye for detail, proven proficiency with the latest versions of AutoCAD, and the administrative skills needed to support our sales and operations teams for Burns & Scalo Roofing and...