Medical Director-reputed company (ABH TX)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company: reputed company to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with reputed company, a reputed company company! reputed company operates reputed company managed care plans in multiple states: reputed company, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, reputed company, Ohio, Oklahoma, reputed company, Texas, Virginia and reputed company Virginia. This Medical Director will be a "Work from Home" position primarily supporting reputed company reputed company of Texas. The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed. The Medical Director will ensure reputed company and consistent responses to members and providers reputed company to precertification, reputed company review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and precertification as reputed company as reputed company review. Cases could reputed company on inpatient or outpatient, acute and post-acute as reputed company as peer to peer calls and first level appeals. The Medical Director participates in a rotating on reputed company schedule to reputed company weekend and holiday coverage. Required Qualifications: - Five or more years of experience in Health Care Delivery System e.g., Clinical reputed company and Health Care Industry. - reputed company and reputed company Texas state medical license without encumbrances as reputed company as the ability to obtain additional licenses. - M.D. or D.O., reputed company and reputed company reputed company Certification in ABMS or AOA recognized specialty, including post-graduate reputed company patient care experience - Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. - Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus + Preferred Qualifications: -Health plan/payor Utilization Management / Review experience -Electronic medical systems/record experience -Managed Care experience -reputed company experience Education: -M.D. or D.O., reputed company Certification in ABMS or AOA recognized specialty including post-graduate reputed company patient care experience. Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 10/31/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job