Family Medicine - Physician
Not Disclosed•Full-TimeOn-site
location_on203, West Walker Street, League City, Galveston County, Texas, 77573, United States
About the Team
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created exclusively for children. As the largest combined STAR/CHIP Managed Care Organization in the Harris County service area, we provide essential STAR/Medicaid and Children's Health Insurance Program (CHIP) coverage to pregnant women, teens, children, and adults in Houston and surrounding areas. Our network supports over 375,000 members through a robust system of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.
About the Role
As an Associate Medical Director for Managed Care and Utilization Management, you will join the best-ranked children's hospital in Texas and among the best in the nation. This role is pivotal in establishing health plans and medical policies that drive high-quality care. You will serve as a crucial member of the Health Plan operating team, providing guidance to various departments within Texas Children's Health Plan (TCHP).
In this position, you will oversee assigned functions of the health plan while offering support, education, and consultation to Texas Children's System staff and physicians regarding resource utilization, managed care, and continuity of care. You will work closely with Chief Medical Officers (CMOs) and Medical Directors to continuously improve medical management programs, including discharge planning, case and referral management, and the application of clinical protocols. Your work ensures that the Utilization Management Program reflects current managed care philosophies and the core values of Texas Children's, balancing evidence-based clinical judgment with the needs of our diverse member population.
Hiring Process
Candidates interested in this role should submit their application through the official careers portal. The selection process typically involves a review of qualifications, followed by interviews with the CMOs and relevant department heads to assess clinical expertise, leadership capabilities, and cultural fit within our pediatric-focused organization.
Equal Opportunity
Texas Children's Health Plan is an equal opportunity employer committed to building a diverse and inclusive workforce. We consider qualified applicants regardless of background, race, color, religion, gender, sexual orientation, age, disability, or veteran status.
Work location
Work model: On-site
203, West Walker Street, League City, Galveston County, Texas, 77573, United States
League City, Texas
Key Responsibilities
- check_circleEstablish health plans and medical policies for the organization
- check_circleOversee implementation of medical management programs including discharge planning and case management
- check_circleConduct medical necessity reviews and appeals using evidence-based guidelines
- check_circleDevelop behavioral health care guidelines and practice standards
- check_circleMonitor member outcomes using encounter data and electronic medical records
- check_circleParticipate in Quality Management programs and establish quality improvement standards
- check_circleProvide education and consultation to staff and physicians on resource utilization
- check_circleEnsure regulatory compliance with NCQA, TDI, and federal accreditation agencies
Requirements
- verifiedDoctor of Medicine (M.D.) or Doctorate Doctor of Osteopathic Medicine (D.O.)
- verifiedMDL - Medical Doctor License by the Texas Medical Board
- verifiedBCPP - BC Physician in Psychiatry or BCP - Board Cert Pediatrician or BCFM - Board Cert Family Medicine or BCOBGYN - Board Cert OB-GYN
- verified5 years Healthcare management, managed care experience, and/or behavioral health experience
- verifiedResidency in Psychiatry and Child Psychiatry training (if primary role is Behavioral Health)
Nice to Have
Board certification in Pediatrics and Family Medicine.
Similar Job Opportunities
Skills, education and keywords
Skills: MD, Do, MDL, BCPP, BC, BCFM, Bcobgyn, Ncqa, Tdi, Star.
Education: Required Doctor of Medicine (M.D.) or Doctorate Doctor of Osteopathic Medicine (D.O.).
Frequently asked questions about Family Medicine - Physician at Texas Children's Hospital
What does a Family Medicine - Physician at Texas Children's Hospital do?expand_more
In this Family Medicine - Physician at Texas Children's Hospital role, you will establish health plans and medical policies for the organization; oversee implementation of medical management programs including discharge planning and case management; conduct medical necessity reviews and appeals using evidence-based guidelines; and develop behavioral health care guidelines and practice standards.
What are the requirements for this Family Medicine - Physician role?expand_more
To qualify for the Family Medicine - Physician at Texas Children's Hospital position, applicants should have: Doctor of Medicine (M.D.) or Doctorate Doctor of Osteopathic Medicine (D.O.); MDL - Medical Doctor License by the Texas Medical Board; BCPP - BC Physician in Psychiatry or BCP - Board Cert Pediatrician or BCFM - Board Cert Family Medicine or BCOBGYN - Board Cert OB-GYN; 5 years Healthcare management, managed care experience, and/or behavioral health experience; and Residency in Psychiatry and Child Psychiatry training (if primary role is Behavioral Health).
Where is the Family Medicine - Physician role at Texas Children's Hospital located?expand_more
Family Medicine - Physician at Texas Children's Hospital is based in 203, West Walker Street, League City, Galveston County, Texas, 77573, United States. This is a on-site role.
Is this Family Medicine - Physician job remote, hybrid, or on-site?expand_more
Texas Children's Hospital has listed this Family Medicine - Physician role as on-site.
How much experience is required for this Family Medicine - Physician role?expand_more
Family Medicine - Physician at Texas Children's Hospital typically requires 5+ years of relevant experience at the senior level.
What skills do you need for the Family Medicine - Physician role at Texas Children's Hospital?expand_more
Key skills for Family Medicine - Physician at Texas Children's Hospital include MD; Do; MDL; BCPP; BC; BCFM; Bcobgyn; and Ncqa.
What education is required for Family Medicine - Physician at Texas Children's Hospital?expand_more
Educational requirements for this role: Required Doctor of Medicine (M.D.) or Doctorate Doctor of Osteopathic Medicine (D.O.).
What category does the Family Medicine - Physician role belong to?expand_more
Family Medicine - Physician at Texas Children's Hospital is part of the healthcare & nursing job category on Recrutus.