Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions
Provides medical leadership for utilization management, cost containment, and medical quality improvement activities
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex medical services
Supports effective implementation of performance improvement initiatives for capitated providers
Assists in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service
Collaborates effectively with clinical teams and medical consultants for reviewing complex cases and appeals
Participates in provider network development and new market expansion as appropriate
Develops and implements physician education with respect to clinical issues and policies
Interfaces with physicians for implementation of recommendations to improve utilization and health care quality
Develops alliances with provider community through medical management programs

Medical Doctor or Doctor of Osteopathy
Utilization Management experience and knowledge of quality accreditation standards preferred
Actively practices medicine
Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous
Experience treating or managing care for a culturally diverse population preferred
Board certification by the American Board of Psychiatry and Neurology
Certification in Child Psychiatry, preferred
Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs

Child Behavioral Medical Director

Key skills