- Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs.
- Provide regional medical necessity reviews and cross coverage
- Standardizes UM practices and quality and financial goals across all LOBs
- Supports BH committees for quality compliance.
- Implements clinical practice guidelines and medical necessity review criteria
- Tracks all clinical programs for BH quality compliance with NCQA and CMS
- Ensures all BH programs and policies are in line with industry standards and best practices
- Assists with new program implementation and supports the health plan in-source BH services
- Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry (Child/Adolescent)
- 3 years' experience in Utilization/Quality Program Management
- Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
- Active and unrestricted State ( New Mexico ) Medical License, free of sanctions from Medicaid or Medicare.
- Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
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Medical Director
3 weeks ago
She Recruits, LLC Albuquerque, United StatesJob Title: Medical Director (Locums/1099) · Location: Albuquerque, NM area · Salary: #260k-300k · Company Overview:We are committed to delivering compassionate and comprehensive care to our patients while fostering a collaborative and supportive work environment for our team. A ...
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Medical Director
2 weeks ago
UNM Medical Group Albuquerque, United StatesThe UNM Medical Group, Inc. is hiring for a Medical Director/APP to join our Center for Life Clinic. This opportunity is a part-time to full-time day shift opening located in Albuquerque, New Mexico. We are open to a schedule of 3-5 days a week, FTE. The Center for Life Clinic is ...
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Director, Medical Director
2 days ago
Molina Healthcare Albuquerque, NM, United StatesMolina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. · Provides Psychia ...
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Medical Director
3 weeks ago
She Recruits. LLC Albuquerque, United StatesJob Title: Medical Director (Locums/1099) · Location: Albuquerque, NM area · Salary: · Company Overview:We are committed to delivering compassionate and comprehensive care to our patients while fostering a collaborative and supportive work environment for our team. As we conti ...
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Medical Director
1 week ago
UNM Medical Group, Inc. Albuquerque, United StatesJob Description · Job DescriptionThe UNM Medical Group, Inc. is hiring for a Medical Director to join our Dental Clinic in Albuquerque, NM. This opportunity is for 0.1FTE. The ASC is an AAAHC Accredited site which adheres to the highest standard of patient care and quality. This ...
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Medical Director
1 week ago
UNM Medical Group, Inc. Albuquerque, United StatesJob Description · Job DescriptionThe UNM Medical Group, Inc. is hiring for a Medical Director/APP to join our Center for Life Clinic. This opportunity is a part-time to full-time day shift opening located in Albuquerque, New Mexico. We are open to a schedule of 3-5 days a week, F ...
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Physician/Medical Director
1 week ago
UNM Medical Group Albuquerque, United StatesThe UNM Medical Group, Inc. is hiring for a Physician/Medical Director to join our Center for Life Clinic. This opportunity is a part-time to full-time day shift opening located in Albuquerque, New Mexico. We are open to a schedule of 3-5 days a week, FTE. The Center is a prevent ...
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Clinical Medical Director
3 weeks ago
UnitedHealth Group Albuquerque, United StatesThe Clinical Medical Director, is a member of the leadership team and responsible for the quality, cost and service levels of health care provided by Optum New Mexico. This position works closely with the senior leaders to direct, manage and evaluate all clinical operations. This ...
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Physician/Medical Director
3 weeks ago
UNM Medical Group, Inc. Albuquerque, United StatesThe UNM Medical Group, Inc. is hiring for a Physician/Medical Director to join our Center for Life Clinic. This opportunity is a part-time to full-time day shift opening located in Albuquerque, New Mexico. We are open to a schedule of 3-5 days a week, FTE. The Center is a prevent ...
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Executive Medical Director
3 weeks ago
UNM Medical Group, Inc. Albuquerque, NM, United StatesThe UNM Medical Group, Inc. is hiring an Executive Medical Director. This is a unique opportunity for an APP or Physician looking to expand their career in a part-time to full-time Monday-Friday day shift located in Albuquerque, New Mexico. This position will include FTE administ ...
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Clinical Medical Director
3 weeks ago
Optum Albuquerque, United StatesThe Clinical Medical Director, is a member of the leadership team and responsible for the quality, cost and service levels of health care provided by Optum New Mexico. This position works closely with the senior leaders to direct, manage and evaluate all clinical operations. This ...
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Regional Medical Director
2 weeks ago
Wexford Health Sources Albuquerque, NM, United StatesWexford Health Sources, the nation's leading innovative correctional health care company, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality. For nearly two decades, Wexford Health h ...
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Regional Medical Director
3 weeks ago
Wexford Health Sources Albuquerque, United StatesWexford Health Sources, the nation's leading innovative correctional health care company, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality. For nearly two decades, Wexford Health h ...
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Center Medical Director
2 weeks ago
CSL Plasma Albuquerque, United StatesPlasma Operations · Provides operational initiatives with the goal of aligning center processes, improving operational efficiencies to ensure center development and ultimately to reduce process variation for consistencies within fleet. · Plasma Multi Discipline · Manages two or m ...
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FM Medical Director
2 weeks ago
The Delta Companies New Mexico, United StatesCOMPENSATION AND BENEFITS Family Medicine (FM) · Up to $350,000 Base Salary · 28 Days PTO + 13 Paid Holidays · 403B w/ 6% Match Depending on Longevity · Student Loan Forgiveness through IHS and NHSC · RESPONSIBILITIES AND FACILITY DETAILS Family Medicine (FM) · No weekends, ...
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FM Medical Director
2 weeks ago
The Delta Companies New Mexico, United StatesCOMPENSATION AND BENEFITS Family Medicine (FM) · ~ 28 Days PTO + 13 Paid Holidays · ~RESPONSIBILITIES AND FACILITY DETAILS Family Medicine (FM) · ~ 70% Patient Contact and 30% Administrative · ~QUALIFICATIONS AND SKILLS Family Medicine (FM) · Credentialing 4-6 Weeks · COMMUNIT ...
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Director, Medical Partnerships
3 weeks ago
Central New Mexico Community College New Mexico, United States00 Compensation Type: Salary Employment Type: Regular Grade: E20 Position Summary This position provides oversight of one or more programs within the academic Schools. Is responsible for administration, planning, development and coordination of all aspects of program management. ...
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Medical Director, Behavioral Health
2 weeks ago
Molina Healthcare Albuquerque, United StatesJOB DESCRIPTION · Job Summary · Molina's Behavioral Health function provides leadership and guidance for utilization management and case management and quality programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health c ...
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Medical Director, Behavioral Health
3 days ago
Molina Healthcare Albuquerque, NM, United StatesJOB DESCRIPTION · Job Summary · Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care manageme ...
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Medical Director, Behavioral Health
3 weeks ago
Molina Healthcare Albuquerque, United StatesJOB DESCRIPTION · Job Summary · Molina's Behavioral Health function provides leadership and guidance for utilization management and case management and quality programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health ...
Director, Medical Director - Albuquerque, NM, United States - Molina Healthcare
Description
Molina's Behavioral Health function provides leadership and guidance for utilization management and case management and quality programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.
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