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.

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