Medical Director
Core
Provide medical leadership for utilization management, cost containment, and quality improvement activities for a Medicaid/Medicare business unit.
Role type
Senior Medical Director (Utilization Management & Quality Improvement)
Builds
Utilization management programs, quality improvement initiatives, and provider network strategies
Domain
Healthcare administration / Insurance / Utilization Management
Required skills
Medical leadership, utilization review, quality assurance, performance improvement, provider network development, claims review, clinical policy implementation, stakeholder collaboration, data trend analysis, regulatory compliance
Preferred skills
Health administration/financing knowledge, culturally diverse population management, board certification in Psychiatry
Technologies
None stated
Responsibilities
Direct medical management and credentialing functions, perform medical reviews for complex services, conduct rounds for high-risk patients, collaborate on medical necessity appeals, develop provider alliances, represent the business unit at state committees, identify utilization and quality improvement studies
Seniority
Senior, hands-on IC with strategic oversight