Associate Medical Director - OB/Gyn

77 consultants; Dallas (TX); On-site; USD 250,000 - 300,000; Full time

Job summary

A healthcare recruitment firm is seeking an Associate Medical Director to oversee clinical operations within a managed care framework in Dallas, Texas. The role involves evaluating prior authorization requests, providing clinical oversight for quality management initiatives, and engaging with local organizations. Required qualifications include board certification in OB/GYN and a valid Texas medical license. This position emphasizes leadership and a strong alignment with managed care principles to effectively contribute to the healthcare delivery system.

Qualifications

• Board certification in OB/GYN or a relevant specialty is mandatory.
• A valid Texas medical license (or willingness to obtain) is required.
• Experience in managed care and prior authorization is essential.

Responsibilities

• Oversee and support clinical operations in managed care.
• Evaluate prior authorization and appeals requests.
• Provide clinical oversight for various management initiatives.

Skills

Alignment with managed care philosophy

Knowledge of managed care principles

Leadership skills

Organizational skills

Interpersonal communication skills

Understanding of Medicaid Regulations

Education

Board certification in OB/GYN or relevant specialty

Valid Texas medical license

Job description

Job Title

Associate Medical Director

Position Overview

The Associate Medical Director will actively oversee and support clinical operations, ensuring the provision of comprehensive care within a managed care framework.

Key Responsibilities

• Evaluate prior authorization and appeals requests to determine claims payment based on medical necessity.
• Conduct peer-to-peer discussions as required to facilitate the utilization management process.
• Provide clinical oversight for utilization management, disease management, and quality management initiatives as directed by the Chief Medical Officer (CMO) or Senior Medical Director, including input on the development of medical policies, clinical standards, and guidelines that align with evidence-based medicine.
• Analyze healthcare provider data to create provider profiles and assess physician performance; participate in the review of provider applications and qualifications, addressing any discrepancies in adherence to managed care standards through site and medical record reviews.
• Collaborate with the Senior Medical Director and Pharmacy Director in the management and administration of pharmacy benefits for PCHP members, ensuring coordinated care between medical and pharmacy services.
• Support the Senior Medical Director in overseeing the clinical components of programs addressing fraud, waste, and abuse within PCHP.
• Contribute to the formulation, implementation, and monitoring of annual departmental goals and objectives.
• Identify educational and health promotion needs for members and providers, assessing and enhancing existing educational initiatives to align with managed care service requirements.
• Represent PCHP in clinical matters at state and local organizations, including the Texas Department of Insurance and Texas Health and Human Services Commission, as directed by the CMO or Senior Medical Director.
• Engage in process improvement initiatives concerning job design and workflows, implementing changes to boost operational effectiveness and efficiency within the clinical setting.
• Serve on managed care committees and participate in community and interdisciplinary committees as assigned by the Chief Medical Officer or Senior Medical Director.

Accountabilities

• Analyze job design and workflows to implement strategies that enhance departmental effectiveness, productivity, and efficiency.
• Stay current with developments in the field through seminars, workshops, professional journals, and participation in relevant organizations, integrating new knowledge into practice.
• Maintain up-to-date understanding of laws, regulations, and guidelines affecting the area and develop internal controls to ensure compliance with applicable laws and accreditation standards.
• Construct and manage annual budgets to ensure adequate funding for departmental objectives.
• Develop and revise annual goals and objectives that align with organizational missions; supervise and evaluate staff, providing training and development opportunities while facilitating disciplinary actions as necessary.

Required Skills and Qualifications

• Strong alignment with the managed care philosophy of healthcare delivery.
• Robust knowledge of managed care principles.
• Exemplary leadership, organizational, and interpersonal communication skills, with the ability to engage effectively with executive management, physician groups, community organizations, and diverse populations.
• Proficient understanding of Texas Medicaid Regulations and their applications.

Licensure and Experience

• Board certification in OB/GYN or a relevant specialty is mandatory (no exceptions).
• A valid Texas medical license (or a willingness to obtain) is required.
• A clean malpractice/license history is highly preferred.
• Experience in managed care and prior authorization is essential.
• Participation in a managed care utilization management committee is preferred.
• Capacity to adapt to the managed care delivery model is crucial.