STAR Kids Medical Director

Overview
The STAR Kids Medical Director is responsible for first level physician support for medical management clinical functions, including Utilization Management, Case Management, Clinical Quality, Credentialing and Pharmacy for medically complex pediatric members. These functions support the overall corporate goals of ensuring effective delivery of high quality health care.

Responsibilities
Assisting the  Chief Medical Officers and the other Medical Directors in the following activities:

  • Quality Assessment and Improvement activities
  • Outreach programs
  • Develop clinical practice and preventive guidelines
  • Ensure regulatory and accreditation compliance
  • Serve as a Texas Children’s Health Plan (TCHP) representative in designated local meetings with managers, provider offices, local and state health care organizations
  • Review pharmacy initial and subsequent requests to determine medical necessity.
  • Monitor provider performance
  • Recommend departmental improvements
  • Resource for Medical Management staff for care coordination and management for ambulatory and inpatient services
  • Serve as the primary medical review physician for acute and LTSS services utilization managment
  • Demonstrate collaboration with TCHP staff and management to achieve goals and objectives of the department and organization

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Maintain a Current Unrestricted Texas Physician License
  • Board Certification in Pediatrics, Family Medicine or Obstetrics/Gynecology required

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Commitment to clinical programs and mission to serve the Medicaid population
  • Interest and experience with children with medical complexity preferred
  • Ability to work with colleagues and other health care professionals to resolve utilization and quality management issues
  • Ability to communicate effectively with health professionals, administrators and staff, both orally and in writing
  • Ability to review the medical literature to answer a clinical question
  • Basic computer skills

WORK BACKGROUND/EXPERIENCE
Minimum of two years of experience in a medical leadership role in an integrated care delivery system, group practice or clinic, a provider network, a managed care organization, or a community based health care delivery initiative.

Can demonstrate successful experience in peer review and physician performance evaluation processes.

About Us

Founded in 1996, Texas Children’s Health Plan is the nation’s first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children’s Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. TCHP covers 25,000 medically complex children through STAR Kids. Currently, the Health Plan has more than450,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children’s Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

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