The Role of the Managed Care Medical Director in Case Management

Abstract

Case management is a major element of most managed care organization’s (MCO) medical management programs. Although the responsibility for the actual case management activities rests with a wide range of health care professionals with specialized training, the MCO medical director must take an active role in the development, implementation, and evaluation of the case management program. The medical director’s clinical knowledge and experience makes him or her a valuable consultant for the case manager, and his or her communication and leadership skills allow him or her to take an active role in enhancing the effectiveness of the program both within the managed care organization and in the medical community.