Medical Director, Utilization & Population Health

University-Health-3; San Antonio (TX); On-site; USD 153,000 - 205,000; Full time

Job summary

Community First Health Plans (CFHP) seeks a Medical Director for Population Health Management in Texas. You will lead utilization management across multiple product lines and ensure compliant, timely decisions aligning with CFHP’s mission and Triple Aim Plus objectives.

The role requires an MD/DO with Texas licensure, board certification, and at least 5 years of clinical care experience, including leadership in managed care. Inpatient, LTAC, and Nursing Facility exposure is preferred.

Qualifications

• Medical degree (MD/DO) and active Texas Medical License, free of sanctions.
• Minimum 5 years of direct clinical patient care after residency.
• Leadership experience in managed care and knowledge of utilization review and quality management.

Responsibilities

• Provide clinical leadership and oversight for utilization management across multiple product lines.
• Ensure determinations are accurate, timely, and compliant with standards and policies.
• Collaborate across departments to drive quality, efficiency, and integrated care delivery.

Skills

Clinical leadership

Utilization management

Population health

Regulatory compliance

Education

MD or DO

Texas Medical License

Board certification

Job description

Community First Health Plans (CFHP) seeks a Medical Director for Population Health Management in Texas. You will lead utilization management across multiple product lines and ensure compliant, timely decisions aligning with CFHP’s mission and Triple Aim Plus objectives.

The role requires an MD/DO with Texas licensure, board certification, and at least 5 years of clinical care experience, including leadership in managed care. Inpatient, LTAC, and Nursing Facility exposure is preferred.