Pride Health
Assistant Director of Obstetrics and Gynecology
Pride Health, Dallas, Texas, United States, 75215
Assistant Director of Obstetrics and Gynecology
A leading health plan is seeking an experienced
Associate Medical Director
to provide clinical leadership, utilization management oversight, and operational support within a managed care environment. This role is hands‑on and focuses on ensuring high‑quality, evidence‑based care for members while supporting organizational goals.
Position Overview The Associate Medical Director will support senior clinical leadership in overseeing utilization management, pharmacy coordination, provider performance evaluation, and quality improvement initiatives. The role requires strong knowledge of managed care operations and Texas Medicaid regulations.
Key Responsibilities
Review prior authorization and appeals requests for medical necessity decisions.
Conduct peer‑to‑peer consultations to support utilization management.
Provide clinical oversight for utilization, disease management, and quality programs.
Assist in developing medical policies, coverage criteria, and clinical guidelines.
Analyze provider performance data and participate in provider reviews and evaluations.
Support administration of the pharmacy benefit and coordinate medical‑pharmacy care.
Contribute to oversight of fraud, waste, and abuse programs.
Participate in yearly planning, implementation, and evaluation of organizational goals.
Support provider and member education initiatives.
Assist in representing clinical operations with state and regulatory entities.
Participate in or chair clinical and interdisciplinary committees as assigned.
Identify workflow gaps and implement process improvements for efficiency and compliance.
Strong understanding of managed care delivery models.
Working knowledge of Texas Medicaid regulations.
Expertise in utilization management and prior authorization workflows.
Ability to lead and supervise multi‑disciplinary teams.
Strong communication, negotiation, and organizational skills.
Ability to evaluate clinical treatment plans and apply evidence‑based principles.
Ability to manage confidential information and remain composed under pressure.
Proficiency with computer systems and clinical review tools.
Required
Board Certification in OB/GYN or relevant medical specialty (no exceptions).
Active Texas medical license (or willingness to obtain).
Clean malpractice and license history (highly preferred).
Experience in managed care and prior authorization.
Ability to oversee teams and adapt to managed care workflows.
Preferred
Prior participation on a Managed Care UM Committee.
Competitive salary package; candidates encouraged to share expected range.
Health, dental, and vision coverage.
Career growth opportunities within a mission‑driven organization.
Flexible schedule and strong work‑life balance.
Seniority level
Associate
Employment type
Full‑time
Job function
Health Care Provider
Hospitals and Health Care
#J-18808-Ljbffr
Associate Medical Director
to provide clinical leadership, utilization management oversight, and operational support within a managed care environment. This role is hands‑on and focuses on ensuring high‑quality, evidence‑based care for members while supporting organizational goals.
Position Overview The Associate Medical Director will support senior clinical leadership in overseeing utilization management, pharmacy coordination, provider performance evaluation, and quality improvement initiatives. The role requires strong knowledge of managed care operations and Texas Medicaid regulations.
Key Responsibilities
Review prior authorization and appeals requests for medical necessity decisions.
Conduct peer‑to‑peer consultations to support utilization management.
Provide clinical oversight for utilization, disease management, and quality programs.
Assist in developing medical policies, coverage criteria, and clinical guidelines.
Analyze provider performance data and participate in provider reviews and evaluations.
Support administration of the pharmacy benefit and coordinate medical‑pharmacy care.
Contribute to oversight of fraud, waste, and abuse programs.
Participate in yearly planning, implementation, and evaluation of organizational goals.
Support provider and member education initiatives.
Assist in representing clinical operations with state and regulatory entities.
Participate in or chair clinical and interdisciplinary committees as assigned.
Identify workflow gaps and implement process improvements for efficiency and compliance.
Strong understanding of managed care delivery models.
Working knowledge of Texas Medicaid regulations.
Expertise in utilization management and prior authorization workflows.
Ability to lead and supervise multi‑disciplinary teams.
Strong communication, negotiation, and organizational skills.
Ability to evaluate clinical treatment plans and apply evidence‑based principles.
Ability to manage confidential information and remain composed under pressure.
Proficiency with computer systems and clinical review tools.
Required
Board Certification in OB/GYN or relevant medical specialty (no exceptions).
Active Texas medical license (or willingness to obtain).
Clean malpractice and license history (highly preferred).
Experience in managed care and prior authorization.
Ability to oversee teams and adapt to managed care workflows.
Preferred
Prior participation on a Managed Care UM Committee.
Competitive salary package; candidates encouraged to share expected range.
Health, dental, and vision coverage.
Career growth opportunities within a mission‑driven organization.
Flexible schedule and strong work‑life balance.
Seniority level
Associate
Employment type
Full‑time
Job function
Health Care Provider
Hospitals and Health Care
#J-18808-Ljbffr