Associate Medical Director

1 week ago

Dallas, Texas, United States Parkland Health and Hospital System Full time


Are you looking for a rewarding career opportunity that combines purpose and advancement? Parkland offers a collaborative environment where dedicated healthcare professionals work together to ensure the well-being of individuals and communities in our care.

Join our team and be part of a rich healthcare legacy that has been serving the community for over a century.

Bring your expertise to Parkland, where learning and growth opportunities await you in a skilled team dedicated to delivering exceptional patient care.

Passion drives us.

Primary Purpose

- Evaluate requests for prior authorization and appeals for claims payment based on medical necessity.- Supervise medical coordination to optimize utilization and quality within the health plan network.- Provide support across various clinical functions to ensure high-quality healthcare delivery according to established policies.- Monitor clinical care effectiveness and cost-efficiency to achieve optimal health outcomes.

Minimum Specifications

Education

- Completion of an Accreditation Council for Graduate Medical Education (ACGME) or American Medical Association (AMA) approved residency relevant to the PCHP population.


Experience

- Minimum five years of clinical practice in a specialty related to PCHP members' care, preferably in Pediatrics or Family Practice.
- At least three years of experience in managed care or relevant population care.
- Experience in developing medical policies, procedures, and programs is a plus.

- Qualifications for clinical oversight, including medical or clinical practice background, with a preference for previous participation in a managed care UM committee.


Equivalent Education and/or Experience

Certification/Registration/Licensure

- Current license to practice medicine in Texas.

- Compliance with licensing and registration requirements for Managed Care Medical Directors in Texas.


Required Tests for Placement

Skills or Special Abilities

- Strong understanding of managed care principles and philosophies.
- Proficiency in managed care best practices and leadership skills.- Ability to communicate effectively with diverse stakeholders and demonstrate strong organizational and supervisory abilities.- Knowledge of Texas Medicaid Regulations and care coordination principles.
- Familiarity with healthcare coordination, population health, and evidence-based care evaluation.
- Ability to contribute to business challenges with medical insights for optimal outcomes.

- Detail-oriented with a hands-on approach to tasks.


Responsibilities
- Review and process prior authorization and appeals requests based on medical necessity.- Provide clinical oversight for utilization, disease management, and quality activities as assigned.- Analyze data to assess provider performance and compliance with policies.

- Assist in pharmacy benefit administration and clinical aspects of fraud prevention.

- Support the development, monitoring, and implementation of healthcare goals and objectives.- Participate in community and professional committees to represent PCHP.
Job Accountabilities

- Review and optimize work processes to enhance departmental effectiveness and efficiency.- Stay informed on industry trends and advancements to improve work practices.- Ensure compliance with relevant regulations and develop internal controls for adherence.- Develop and manage budgets, goals, and objectives aligned with the department and organizational missions.- Lead, train, and support team members to maximize their potential and knowledge growth.
Parkland Health and Hospital System upholds a commitment to diversity and inclusion, prohibiting discrimination based on various factors. As part of our wellness initiatives, Parkland Health maintains a tobacco and smoke-free campus.

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