Support Staff: Multidisciplinary teams within managed care and clinical operations
Core
Responsibilities: Review prior authorization & appeals for medical necessity Peer-to-peer provider reviews Clinical oversight for UM, disease management, and quality management Develop medical policies, clinical guidelines, and coverage rules Analyze provider performance data Review provider applications and quality concerns Oversight of; pharmacy benefit coordination,fraud, waste, and abuse clinical aspects Participate in regulatory interactions (state/local agencies), managed care committees Support development & monitoring of annual organizational goals Evaluate job design, workflows, and processes for improvement Ability to interpret/understand Texas Medicaid regulations Demonstrate leadership, communication, and managed-careoriented skills Application of medical knowledge within operational/business environments
Other Info: Locum-to-perm transition expected
Travel, lodging, and malpractice insurance covered