This position is open as of 11/3/2009.
Medical Director, Director of Utilization Management - Board Certified, Texas Licensed Physician
Medical Director, Director of Utilization Management - Board Certified, Texas Licensed Physician - San Antonio, TX
If you are a Medical Director or Director of Utilization Management who is Board Certified and a Texas Licensed Physician, please read on!
What you need for this position:
- Doctor of Medicine (M.D.) degree required.
- Board Certified Family Practitioner or Internal Medical Specialist required.
- Five or more years of clinical practice experience required.
- Two or more years of experience in utilization management activities required.
- Texas Licensed Medical Physician or Doctor of Osteopathy required.
- Eligible for Florida Medical License required.
- Proficiency with Microsoft Office applications required.
Preferred Education, Experience & Skills
• Two years of experience working in a managed care health plan environment preferred.
• Bilingual (English/Spanish) fluency preferred.
What you'll be doing:
- The Medical Director for Utilization Management will be making utilization management determinations on case by case basis, identifying utilization trends and suggesting possible over or under utilization of service, and proactively suggesting improvements to utilization management program.
Essential Job Functions
- Receives, reviews and processes individual determination requests and prior-authorization requests.
- Provides strategic utilization management oversight and direction to member facilities, including acute care hospitals, long term acute care hospitals, acute rehabilitation hospitals and skilled nursing facilities.
- Conducts post service reviews issued for medical necessity and benefits determination coding.
- Performs analysis of utilization data and suggests/implements corrective action plans with network physicians.
- Performs all other related duties as assigned.
So, if you are a Medical Director or Director of Utilization Management who is Board Certified and a Texas Licensed Physician, please apply today!
Required Skills
Medical Director, Director of Utilization Management, Board Certified, Texas Licensed Physician, Medical Utilization, Utilization Management, Managed Care, Doctor of Medicine, Clinical Practice, Osteopathy
If you are a good fit for the Medical Director, Director of Utilization Management position, and have a background that includes:
Medical Director, Director of Utilization Management, Board Certified, Texas Licensed Physician, Medical Utilization, Utilization Management, Managed Care, Doctor of Medicine, Clinical Practice, Osteopathy and you are interested in working the following job types:
Healthcare, Nurse, Pharmaceutical
Within the following industries:
Healthcare - Health Services, Pharmaceutical, Chemical
Our privacy policy: Your resume and information will be kept completely confidential.
Looking forward to receiving your resume through our website and going over the job in more detail with you!