Family Medicine - Physician
Not Disclosed•Full-TimeOn-site
location_onLight Company Road, Houston, Harris County, Texas, 77506, 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 for our pediatric population.
In this position, you will serve as a crucial member of the Health Plan operating team, providing guidance to various departments within the Texas Children's Health Plan (TCHP). 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 issues. Working closely with Chief Medical Officers (CMOs) and Medical Directors, you will continuously improve the implementation of medical management programs, including discharge planning, case and referral management, and the use of clinical protocols.
Your day-to-day impact involves developing standards for behavioral health care, practice guidelines, and medication management. You will ensure regulatory compliance and oversee the clinical professional review of behavioral health care. By analyzing data from encounter and claims information, you will monitor member outcomes and identify strategies to improve care quality. Additionally, you will ensure that office sites and medical records meet the rigorous standards of accreditation agencies such as NCQA and TDI, preparing the organization for inspections and reviews.
Hiring Process
Candidates selected for this role will be expected to demonstrate excellent communication and conflict resolution skills, providing timely and accurate oral and written progress reports at staff meetings. The role involves active participation in committees affecting patient care, medical policy, and teaching programs, as well as interacting with outside agencies including primary HMOs, state and federal agencies, and professional organizations.
Equal Opportunity
Texas Children's Health Plan is committed to fostering a diverse and inclusive environment. We consider qualified applicants regardless of background, ensuring that our team reflects the communities we serve.
Work location
Work model: On-site
Light Company Road, Houston, Harris County, Texas, 77506, United States
Houston, 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_circleDevelop standards for behavioral health care, practice guidelines, and medication management
- check_circleConduct medical necessity reviews and appeals based on evidence-based guidelines
- check_circleParticipate in Quality Management programs and establish Quality Improvement standards
- check_circleProvide education and consultation to staff and physicians on resource utilization and managed care
- check_circleSupervise clinical professional reviews of behavioral health care by registered nurses
- check_circleMonitor member outcomes using encounter, claims, and electronic medical record data
- check_circleEnsure regulatory compliance with NCQA, TDI, and other 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 - Cert-Board Cert Pediatrician or BCFM - Cert-Board Cert Family Medicine or BCOBGYN - Cert - Board Certified 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
Day-to-day, the Family Medicine - Physician at Texas Children's Hospital will establish health plans and medical policies for the organization; oversee implementation of medical management programs including discharge planning and case management; develop standards for behavioral health care, practice guidelines, and medication management; and conduct medical necessity reviews and appeals based on evidence-based guidelines.
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 - Cert-Board Cert Pediatrician or BCFM - Cert-Board Cert Family Medicine or BCOBGYN - Cert - Board Certified 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 Light Company Road, Houston, Harris County, Texas, 77506, 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.