Associate Medical Director / Physician Reviewer - Utilization Management

Position: Associate Medical Director / Physician Reviewer - Utilization Management

Job ID: 150987

Location: US-TX-Bellaire


Talent Area: Physician

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: M-F 8a-5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


We are searching for an Associate Medical Director to work as a Physician Reviewer — someone who works well in a fast-paced setting. In this position, you'll provide guidance to areas within departments of the organization’s Health Plan.

Think you’ve got what it takes?

Responsibilities :

  • Oversees and provides recommendations to continuously improve the implementation of medical management programs as outlined in the policy and procedures
  • Provides input into the development of medical care guidelines for utilization of behavioral health services
  • Develops guidelines and ensures office sites and medical records meet the standards for proper behavioral health care
  • Monitors outcomes of members
  • Works with personnel in exceeding requirement of federal, state and accreditation agencies, and prepares for inspection and reviews by the above agencies
  • Participates in other committees as directed


  • Doctor of medicine (M.D.) or (DO) 
  • Medical Doctor License by Texas Medical Board
  • Board Certified Physician in Pediatrics 
  • 5 years of clinical and/or health care management/managed care experience
  • Residency in Pediatrics 

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