Per Diem Medical Director Utilization Management

Job Summary

Reporting to the Senior Medical Director of UM, the Per Diem UM Medical Director will be responsible for:

• Performing daily medical reviews, appeals, participating in appeal panel as appropriate, correspondence regarding review determinations and physician peer review activities.
• Identifying and implementing evidence-based practice guidelines throughout the provider network.
• Overseeing the quality of clinical care for network and non-network providers.
• Utilizing evidence-based standards in making coverage determinations.
• Managing day-to-day operations and monitoring the integration and processing of members to optimize appropriate use of behavioral and physical health services.
• Participating with Quality Improvement and Medical Excellence in the identification and analysis of medical and behavioral health information to develop interventions to improve clinical effectiveness of medical management strategies.
• Working closely with a multidisciplinary team to ensure behavioral health management and quality management programs are meeting contractual obligations.
• Working with the leadership of the Quality Improvement and Medical Excellence departments to develop competent clinical staff.
• Attending case management meetings and monthly rounds as scheduled.
• Collaborating with the integrated case management team, during scheduled meetings and informally as needed.
• Thoroughly documenting all care coordination activity in the member medical record in the electronic case management documentation system.

Accountabilities

• Ensures the provision of quality and clinically sound services to all Enrollees by associates and Providers.
• Serves as medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for all clinically related activities.
• Serves as the medical advisor and manager for