Medical Director, Utilization Management- CFHP
Company: University Health
Location: San Antonio
Posted on: February 16, 2026
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Job Description:
POSITION SUMMARY/RESPONSIBILITIES Reporting to the Chief Medical
Officer, this position provides clinical leadership and oversight
for utilization management activities across multiple product
lines. while supporting the multidisciplinary member centric
approach to care management. This role ensures all determinations
are accurate, timely, and compliant with regulatory standards,
contractual requirements, and health plan policies while promoting
a member-centric approach aligned with Community First Health
Plans, Inc., (Community First) mission, vision, and Triple Aim Plus
objectives, improving population health outcomes, enhancing member
experience, containing costs, and improving access to care. The
Medical Director collaborates across departments to drive quality,
efficiency, and integrated care delivery. EDUCATION/EXPERIENCE A
medical degree as Doctor of Medicine (MD) or Osteopathy (DO) and an
active and unrestricted Texas Medical License, free of sanctions
from Medicaid or Medicare is required. A m inimum of five years of
direct clinical patient care experience post residency is required.
Clinical experiences in inpatient, LTAC, and Nursing Facility
setting are preferred. A minimum of two years' experience in
population health management is preferred. Prior leadership
position in managed care, with a comprehensive understanding of
utilization review and quality management procedures, including
Medicaid, Medicare, Commercial and Marketplace programs, is highly
desirable. A primary care specialty is also preferred.
LICENSURE/CERTIFICATION Current unrestricted license as Doctor of
Medicine or Osteopathy for Texas is required. Board certification
is required.
Keywords: University Health, Georgetown , Medical Director, Utilization Management- CFHP, Healthcare , San Antonio, Texas
