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UnitedHealth Group
Houston, TX, United States
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilizati
Job Source: UnitedHealth GroupAdelphi Medical Staffing, LLC
Houston, TX, United States
Job Quick Facts: Specialty: Medical Director Job Type: Permanent Facility Location: Houston, TX Service Setting: Inpatient Reason For Coverage: Vacancy Coverage Type: Call Only Work Schedule: 12 OR 24-hr Shifts - Rotating Weekends; Flexible - Dual OB Hospitalist Teams Annual Deliveries: 11,000 Babies Physician in Practice: 2 (24/7) Specialty Backu
Job Source: Adelphi Medical Staffing, LLCElevance Health
Houston, TX, United States
Wellpoint, formerly Amerigroup, is a proud member of Elevance Health’s family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid plans in partnership with blue cross blue shield plansThis is an individual contributor role. This position will work a hybrid model (remote and office).
Job Source: Elevance HealthMedVet
Houston, TX, United States
Description MedVet has an opportunity for a strong Medical Director who is looking to grow our Specialty hospital in Houston, Texas. MedVet is the nation's premier veterinary-owned and led organization , where doctors have the support of veterinary leadership committed to medical excellence and continuous resource improvement while enjoying own
Job Source: MedVetBlue River PetCare
Houston, TX, United States
We are seeking a kind, compassionate Medical Director to join our four-DVM, small animal practice in northwest Houston! WHY FAIRBANKS ANIMAL CLINIC? • Founded in 1982, we have a well-established and loyal clientele with amazing patients! • We foster a family-oriented, collegial atmosphere. We prefer to bounce ideas off one another and discuss cases
Job Source: Blue River PetCareAccuity
Houston, TX, United States
Job Type Full-time Description The Medical Director, working together with a coder (DRG Integrity Specialist), will review inpatient charts to ensure the acuity and complexity of the patient's hospital stay is appropriately captured in the clinical documentation and translated into coding. The Medical Director is responsible for capturing the true
Job Source: AccuityBlue River PetCare
Houston, TX, United States
We are seeking a kind, compassionate Medical Director to join our four-DVM, small animal practice in northwest Houston! WHY FAIRBANKS ANIMAL CLINIC? • Founded in 1982, we have a well-established and loyal clientele with amazing patients! • We foster a family-oriented, collegial atmosphere. We prefer to bounce ideas off one another and discuss cases
Job Source: Blue River PetCareTeamHealth
Houston, TX, United States
Join TeamHealth's growing post-acute care team in the eastern Houston, Texas, area. This is an excellent opportunity to oversee and provide quality compassionate care by rounding on adults at 5 skilled nursing facilities as a facility medical director. TeamHealth currently offers post-acute services to 150+ facilities throughout the state of Texas.
Job Source: TeamHealthHouston, TX, United States
About the Role
Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As a physician, you will work with the actuarial, technology, medical care coordination, and medical quality management teams. You will report directly to the Chief Medical Officer.
About Evry Health and Globe Life
We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.
Globe Life has recently acquired Evry Health. Globe Life (NYSE:GL) has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.
Key Responsibilities
Utilization management.
Medical policy.
Leading, and working with, the Utilization Management Review Committee.
Development of new medical policies.
Incorporating regulatory updates, and care guideline updates into medical policy.
Medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members.
Promote positive relations with the local medical community, including periodic consultation with providers, facilities, care givers, etc.
Reviews case management data, identifies trends and gaps in care and recommends corrective actions.
Provides oversight and direction for staff and provider training and education.
Integration of clinical quality and demonstrated best clinical practices into medical management program development. Evaluates the development of new and continuation of existing programs. Investigates future care management and patient engagement technologies and evaluates their impact on providers’ practices, patient safety and patient experience.
Qualifications
Active Texas (TX) medical license.
A degree as a Medical Doctor is required, with 4+ years of clinical experience in the practice of medicine.
Must have at least 2 years experience working within a health insurance plan, with an emphasis on population health.
Board certification in a medical specialty recognized by the American Board of Medical Specialists. Current state license as a MD without restrictions, limitations or sanctions from government programs.
Experience in managed care and utilization management.
Knowledge of managed care systems, quality improvement and clinical acumen.
Experience performing utilization management within a health plan.
Experience with MCG or other care guidelines.
Telecommuting Requirements
Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
Ability to keep all company sensitive documents secure.
Must live in the United States.
Must live in a location that receives an existing high-speed internet connection/service.
Location and Benefits
This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
Company business hours are weekdays 9-5 CST. Medical staff have alternating shifts weekends 9-noon CST.
Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, and vacation.
Employment Status
Full time - Salary.
Minimum Required Education
A degree as a Medical Doctor is required.
Experience
4+ years of clinical experience in the practice of medicine. Management experience preferred. Experience working within a health insurance plan is required.
To Apply
Please attach your resume when submitting through this LinkedIn posting.
The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description. Evry Health is an EEO employer (see https://www.eeoc.gov/sites/default/files/2022-10/EEOC KnowYourRights screen reader 10_20.pdf)
Email Alert for REMOTE: Medical Director, Utilization Management and Medical Policy jobs in Houston, TX, United States
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