This position supports the clinical vision for the health plan(s) for all lines of business (Medicaid, Medicare, and Commercial)
implements programs to support this vision.
May serve multiple health plans managed by the Clinical Center of Excellence.
Provides clinical leadership to the interdisciplinary Medical Management team.
Provides day to day physician oversight to an assigned interdisciplinary UM team.
Follows high risk cases throughout treatment continuum from inpatient, rehabilitation, partial hospitalization, outpatient and other levels of care.
Ensures that persons with severe, complex, and/or treatment resistant illnesses receive medically necessary coordinated care throughout the episode of treatment.
Involvement in the development of case management plans.
Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most cost-effective setting.
Evaluates the effectiveness of UM practices and criteria.

Doctor of Medicine (MD) degree OR Doctor of Osteopathic Medicine (DO) degree OR Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of United States based internship and residency (and successful completion of United States based fellowship for subspecialists) required.
Successful completion of the ECFMG and FLEX examinations.
Full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME).
Post-residency experience of at least 3 years involving substantial direct patient care during this period at multiple levels of care.
Clinical experience pertinent to the patient population(s) being managed.
Unrestricted current and valid license or certification to practice medicine in a state or territory of the United States.
Ability and desire to lead through and effect appropriate changes.
Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance and continuous quality improvement (CQI) processes.

comprehensive benefits package
health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Medical Director – Behavioral Health

Key skills