Medical Director

• This position supports the clinical vision for the health plan(s) for all lines of business (Medicaid, Medicare, and Commercial) and implements programs to support this vision.
• Provides clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers in order to address cost and quality of care.
• Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and medical necessity decisions.
• 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.
• Develop and implement 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.

Medical Director – Behavioral Health

• Leverage your background in Pain Medicine disciplines to deliver evidence-based medical reviews that support high-quality patient care.
• Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases.
• Start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success.
• Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software.
• Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment.
• Leverage your clinical expertise to recommend alternative services or treatments as necessary.
• Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

Medical Director – Pain Medicine

• You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success.
• Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software.
• Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment.
• Leverage your clinical expertise to recommend alternative services or treatments as necessary.
• Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

Medical Director – Medical Genetics, Genomics

• Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
• Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions
• Participate in the development, implementation, and evaluation of clinical/medical programs
• Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training
• Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care
• Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff

• 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.

See all jobs on JobTailor

Medical Director – Behavioral Health

Medical Director – Pain Medicine

Medical Director – Medical Genetics, Genomics

Medical Director – Behavioral Health

Medical Director – Behavioral Health