Medical Director (Behavioral Health)
Necnic Group – Des Moines, IA – Des Moines, IA – Medical Director (Behavioral Health) Position Purpose: Assist the VP of Clinical Programs to direct and coordinate the physician component of the utilization management functions for the health plan business units. Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants Performs case reviews and appeals for all health plans. Assists VP of Clinical Programs in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Identifies utilization review studies and evaluates adverse t… – Permanent – Full-timeApply for this job.