Obstetrics/Gynecology Hospital Based job located in Texas

Seeking a Locum to Perm OB/GYN Associate Medical Director 
--This need will be FULLY remote while the provider is working locums, but they will need to transition to a hybrid model once they go perm.
--Monday- Friday 8am-5pm
--This is a 13-week locum assignment with the hope that the provider will transition into a permanent role. 
--Reviews prior authorization and appeals request for approval or denial of claims payment based on medical necessity. 
--Performs peer to peer calls as necessary to support the utilization management process. 
--Provides clinical oversight for utilization management, disease management and quality management activities as assigned by the Chief Medical Officer or Sr. Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine. 
--Analyzes data to establish health care provider profiles and define acceptability of physician performance, conducts review of provider applications and qualifications, and participates in the review process of providers who fail to meet required standards, site and medical record reviews, as appropriate, to ensure adherence to managed care and policies. 
--Assists the Sr. Medical Director and the Pharmacy Director in overseeing and administering the pharmacy benefit for members including coordination of care between the Medical and Pharmacy benefits.  
--Assists the Sr. Medical Director in oversight, evaluation, and administration of the clinical aspects of fraud, waste and abuse programs. 
--Participates in development, implementation, and monitoring of annual goals and objectives for that support the mission and objectives of our facility. 
--Assists in identifying member and provider needs for education and health promotion. Participates in assessment of existing education programs offered to providers, developing and evaluating such programs, as required, to ensure that managed care service area and needs are appropriately served. 
--As assigned by the Chief Medical Officer or Senior Medical Director assists in representing our facility on clinical activities with relevant State and local bodies such as the Texas Department of Insurance, Texas Health and Human Services Commission, and Texas Medical Association. 
--Participates in identification and analysis of process improvement of jobs design, work processes, and work flows for the clinical area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the managed care delivery system. 
--As assigned by the Chief Medical Officer or Sr. Medical Director, serves as chairperson or member of managed care committees, and participates on various community and interdisciplinary committees.  
--Required: BC OBGYN,  TX license or able to obtain, experience in managed care and prior authorization, ability to adapt to the managed care delivery model and oversee a multi-disciplinary team, familiarity with Texas Medicaid Regulations

Job ID 2710