Medical Director - Utilization Management - Texas Children's Health Plan

Bellaire, TX

full-time
Inpatient and outpatient

We are searching for a Medical Director of Utilization Management - The Health Plan - someone who works well in a fast-paced setting. In this position, you will be responsible for establishing health plan medical policies, guidelines, and review criteria.  The Medical Director provides: guidance to areas within departments of Texas Children’s Health Plan (TCHP); oversees assigned functions of the health plan, provides support, education and consultation to Texas Children’s system staff and physicians regarding resource utilization, managed care and population health management. Works in coordination with Director of Utilization Management to ensure appropriate analysis and implementation of medical policy.

Qualifications:

  • Doctor of Medicine (M.D.) required
  • Medical License from the Texas Medical Board required in addition to one of the following: 
    • BCP certification from the American Board of Pediatrics
    • BCFM certification from the American Board of Family Medicine
    • BCPP certification from the American Board of Psychiatry & Neurology
    • BCOBGYN certification from the American Board of Obstetrics & Gynecology
  • 5 years of healthcare management, managed care experience, and/or behavioral health experience required
  • Work history experience in a Managed Care Organization (MCO) required.


Posted February 9, 2021