Associate Medical Director - Managed Care, Utilization Management
On-site · Bellaire, Texas, United States
Job Summary
Associate Medical Director - Managed Care, Utilization Management at Texas Children's Health Plan in Bellaire, TX. Oversees medical management programs, discharge planning, case and referral management, and the use of clinical protocols and medical review criteria; provides guidance on behavioral health guidelines and medication management; ensures regulatory compliance with NCQA and TDI; reviews medical necessity and denials using evidence-based guidelines; develops clinical guidelines with CMOs; educates providers and staff; monitors outcomes using encounter data and EMRs; participates in committees and quality improvement activities; ensures quality of care and adherence to standards across the health plan.
Required Qualifications
- MD or DO
- MD/DO license by Texas Medical Board
- Board certification in Pediatrics or Family Medicine preferred
- 5 years healthcare management or managed care experience
- Residency in Psychiatry and Child Psychiatry training if behavioral health is primary role
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