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Senior Medical Director, Behavioral Health - New Mexico
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$422,520 a year
Full-time
- The Senior Medical Director ensures the delivery of appropriate health care by overseeing the service coordination, utilization management, care/case management, population health/disease management, cost of care, health promotion, quality improvement programs, and the medical action plans for the assigned business unit and/or designated health plans within a national region.
- Ensures compliance with case management and disease management programs and clinical goals through regular monitoring of case management center performance.
- Provides medical leadership, oversight, and consultation for Quality Improvement (QI) Programs including monitoring effectiveness and compliance with goals, prevention programs, network development and management, quality of care concerns and adverse incidents, medical practice of network or sub-capitated providers, clinical service delivery system, coordination with After Hours Team, and oversight of clinical appeals.
- Develops and manages medical director and physician advisor budgets, travel budgets, and continuing medical education budgets.
- Assesses technology and clinical practice standards developed by the company and participates in management of the inter-rater reliability process to ensure consistency between reviewers.
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