Description & RequirementsThis Medical Director, with a focus on behavioral health, provides key clinical support to the Chief Medical Officer in areas of population health management, utilization management and care management.
What You Can Expect: - Provide timely utilization management, case management, and behavioral health support related to preauthorization, appeals, peer-to-peer discussions, clinical rounds, and daily operations.
- Provide leadership and accountability for efficient, timely and evidence-based medical policy development.
- Provide clinical oversight and support for compliance activities, and assists operations/programs to comply with accreditation and regulatory standards, including but not limited to National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS) standards and requirements.
- Assist with utilization management, case management, and behavioral health policy and procedure updates.
- Serve on various operational committees as directed by the CMO pertaining to utilization management, population health management and case management.
- Participate, lead, and support quality improvement projects to meet or exceed National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS) standards and requirements.
- Assist in evaluation of complaints or concerns regarding quality of care.
- Maintain accountability for medical programs and associated data collection and reporting requirements.
- Foster positive relationships with healthcare providers, including hospitals, physicians and allied healthcare professionals.
- Collaborate with the network management team to assess provider performance and address issues related to quality of care, utilization management, and member satisfaction.
- Analyze data and trends to identify opportunities for improving healthcare delivery and cost-efficiency.
- Ensure that clinical policies are communicated effectively to internal stakeholders and network providers.
- Monitor and report on key quality metrics, driving continuous improvement in healthcare outcomes.
- Other duties as requested.
Qualifications: - Education: Graduate Medical School accredited by the Liaison Committee on Medical Education (LCME).
- Experience: Five (5) years clinical practice in a specialty recognized by the American Board of Medical Specialties (ABMS)
- Licenses/Certifications:
- Current medical license in the state of Idaho.
- Current Board certification in a specialty recognized by the American Board of Medical Specialties (ABMS).
Preferred Qualifications: - Experience in Behavioral Health
What's In It For YouAt St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
