Medical Director, Utilization Management- CFHP

Job description

POSITION SUMMARY/RESPONSIBILITIES
This position provides clinical leadership and oversight of the population health management program including utilization management, case management, preventive health/disease management, and quality management while supporting the multidisciplinary member-centric approach to care management. Actively participates with staff across the organization – this is essential to facilitate integrated service delivery, planning, quality assurance, and risk management and to address the needs of members and their families to protect and promote the healthcare of members.
EDUCATION/EXPERIENCE
A medical degree as Doctor of Medicine (MD) or Osteopathy (DO) and an active and unrestricted Texas Medical License, free of sanctions from Medicaid or Medicare is required. Minimum of five year of direct clinical patient care experience post-residency is required. Minimum two years' experience in a medical leadership role is preferred. Previous experience in a leadership position in managed care is preferred, with knowledge and understanding of utilization review and quality management procedures.
LICENSURE/CERTIFICATION
Current unrestricted license as a Doctor of Medicine or Osteopathy for Texas is required. Board certification is required.