Medical Director – BH, UM

🕒 4 days ago

🌺 Hawaii – Remote

🌺 Hawaii – Remote

💵 $200.3k - $360.5k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $101M Private Equity Round on 2004-01

Consulting • Insurance • Healthcare

Magellan Health is a leading healthcare management company that provides a range of services, including behavioral health, pharmacy management, and employee assistance programs. The company focuses on delivering high-quality care and support to individuals and families, particularly those in military and community settings. Magellan Health emphasizes personalized service and innovative solutions to improve health outcomes and enhance the overall patient experience.

📋 Description

• Support the clinical vision for health plans across Medicaid, Medicare, and Commercial lines of business • Implement clinical programs supporting the health plan vision • Provide clinical leadership and physician oversight to interdisciplinary Medical Management and UM teams • Consult with and train care managers regarding cost and quality of care • Participate in case management of high-risk cases and make medical necessity decisions • Follow high-risk cases across inpatient, rehabilitation, partial hospitalization, outpatient, and other levels of care • Ensure medically necessary coordinated care for people with severe, complex, or treatment-resistant illnesses • Develop and implement Utilization Management programs and action plans • Evaluate UM practices and criteria and monitor over- and under-utilization • Lead knowledge, implementation, training, and supervision of medical necessity criteria • Implement clinical practice standards and policies • Develop, implement, and interpret medical policy, technology assessments, and medical necessity guidelines • Build relationships with practitioners, provider facilities, treatment programs, and client organizations • Conduct peer review and educational interventions with psychiatrists and other practitioners • Address quality-of-care concerns and ensure contract, accreditation, state, and federal requirements are implemented • Support continuous quality improvement and utilization/case management compliance • Participate in internal and external appeals processes • Investigate adverse incidents and quality-of-care concerns • Prepare for NCQA and URAC certifications • Lead NCQA-compliant clinical quality improvement activities • Participate in committees, project teams, and Joint Operations Committee work • Support the senior medical director with medical action plans and parity analyses • Maintain licensure requirements for other assigned states • Provide after-hours coverage and meet health plan and Magellan deliverables outside typical business hours • Perform other duties as assigned

🎯 Requirements

• Targeted specialties: Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, or Physical Medicine • Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or international MBBS degree required • International MBBS candidates must successfully complete a United States-based internship and residency, and fellowship for subspecialists • Successful completion of the ECFMG and FLEX examinations • Full training in a United States- or Canada-based residency program approved by ACGME • At least 3 years of post-residency experience involving substantial direct patient care at multiple levels of care • Clinical experience pertinent to the managed patient populations • Unrestricted, current, and valid license or certification to practice medicine in a United States state or territory • Board certification by ABMS or a specialty board • Ability and desire to lead and effect appropriate changes • Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance, and continuous quality improvement processes • Active Hawaii licensure required • After-hours coverage may be required

🏖️ Benefits

• Short-term incentives may be available • Comprehensive benefits package • Health benefits • Life benefits • Voluntary benefits • Benefits and perks supporting physical, mental, emotional, and financial wellbeing • Tobacco-free workplace

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume