Medical Director - Health Plan

At Presbyterian Healthcare Services, we are looking for an innovative, compassionate, and experienced Medical Director - Health Plan to join our team. Our ideal candidate will have the skills and experience to lead our health plan while having the personal touch to make the patient experience the best it can be.The Medical Director - Health Plan will be responsible for developing and implementing medical policies, overseeing utilization management plans, and providing medical direction for the health plan. Additionally, the Medical Director - Health Plan will provide medical advice to the health plan staff, physicians, and other providers to ensure the delivery of high-quality, cost-effective healthcare services.Required Qualifications:• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) who is board-certified in the specialty applicable to the practice, as appropriate• Current, valid, and unrestricted license to practice medicine in the applicable state• Minimum of three years of managed care experience• Demonstrated experience in the interpretation and application of medical policies• Experience in utilization management• Knowledge of healthcare systems, services, and regulations

Responsibilities: • Develop and implement medical policies. • Oversee utilization management plans. • Provide medical direction for the health plan. • Provide medical advice to health plan staff, physicians, and other providers. • Ensure delivery of high-quality, cost-effective healthcare services. • Monitor and evaluate the quality of care provided by physicians and other providers. • Monitor utilization and cost trends to ensure cost containment. • Keep abreast of medical and legal trends related to managed care. • Monitor compliance with federal, state, and local regulations. • Develop and implement provider education programs. • Participate in the development of health plan strategic plans. • Participate in health plan provider and member satisfaction surveys.

According to JobzMall, the average salary range for a Medical Director - Health Plan in Albuquerque, NM, USA is $179,859 to $325,000. The exact salary depends on a number of factors, such as the employer, experience, and education of the individual.

Presbyterian Healthcare Services is a private not-for-profit health care system and health care provider in the State of New Mexico. It owns and operates 8 hospitals in 7 New Mexico communities. It also operates Presbyterian Health Plan.