• Provides clinical leadership and direction to utilization & care management functions of Martin’s Point’s Health Plans • Works collaboratively with other plan functions that interface with Medical Management such as Health Management, Compliance and Appeals, Network Management, Member Services, benefits & claims management, and Compliance. • Assists in or drives short and long-range clinical programming, quality management, and external relationships. • Reports to the Vice President Health Plan Medical Director and works closely with other Health Plan leaders. • Responsible and accountable to the Health Plan Medical Director for helping to manage health plan medical costs by assuring clinically appropriate health care delivery for health plan products and services utilizing Evidence-Based Guidelines.