
This role is an Associate Medical Director position within the Managed Care and Utilization Management department at Texas Children's Health Plan, a top-ranked children's hospital system. The incumbent will establish health plans and medical policies while providing guidance to internal departments and external physicians regarding resource utilization and continuity of care. Key responsibilities include overseeing discharge planning, case management, and behavioral health care guidelines, conducting medical necessity reviews based on evidence-based criteria, and ensuring regulatory compliance with agencies such as NCQA and TDI. The position appeals to candidates seeking to impact the health outcomes of over 375,000 members within a collaborative, mission-driven environment focused on pediatric excellence. The role involves working closely with Chief Medical Officers and quality committees to drive quality improvement strategies and professional education.











