Texas Children's Hospital - Southwest Houston, TX
posted 21 days ago
Full-time - Senior
Remote - Southwest Houston, TX
Hospitals
About the position
The Associate Medical Director at Texas Children's Hospital is a senior-level role responsible for establishing health plans and medical policies within the Texas Children's Health Plan (TCHP). This position involves providing guidance and oversight to various departments, ensuring compliance with regulations, and supporting the implementation of medical management programs. The role requires collaboration with Chief Medical Officers (CMOs) and Medical Directors to enhance behavioral health care standards and improve patient outcomes.
Responsibilities
- Oversee and provide recommendations to improve medical management programs including discharge planning and case management.
- Develop standards for behavioral health care and medication management in collaboration with CMOs.
- Ensure regulatory compliance in clinical professional reviews of behavioral health care.
- Complete medical necessity reviews and document denials of services not meeting medical necessity.
- Develop guidelines for office sites and medical records to meet behavioral health care standards.
- Educate providers on the use of physician profiles and monitor outcomes using data from claims and electronic medical records.
- Participate in quality management programs and collaborate on establishing quality improvement standards.
- Provide timely and accurate progress reports to CMOs and participate in committees affecting patient care.
Requirements
- Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.)
- Medical Doctor License by the Texas Medical Board
- Board Certified in Psychiatry or Pediatrics or Family Medicine or OB-GYN
- 5 years of healthcare management or managed care experience
- Residency in Psychiatry and Child Psychiatry training preferred
Nice-to-haves
- Experience in Family Practice and Pediatric care
Benefits
- Hybrid/Remote Work Schedule Available
