Medical Director

About the role

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work. This 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.

Responsibilities

• 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.

Requirements

• 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).

Skills

• Experience in Behavioral Health (preferred qualification).