Medical Director

This is a fully remote position, open to applicants in California.

📋 Description

• Directly report to the Senior Medical Director while also having a dotted line to the Chief Officer for Health and Innovation.

• Ensure the provision of high-quality, efficient, and comprehensive healthcare services throughout the entire continuum of care.

• Develop and execute Utilization Management policies and procedures.

• Improve care efficiency and quality through effective management of the healthcare network.

• Establish and maintain collaborative partnerships with key providers and thought leaders.

• Offer leadership and guidance to UMC primary care and specialist physicians.

• Co-chair committees related to utilization management, quality management, peer review, and patient safety as needed.

• Interact with health plans concerning benefits, coverage issues, appeals, and HMO hearings.

• Manage care in a cost-effective manner while ensuring health outcomes are not compromised.

• Facilitate clinical rounds with Case Managers and Management to achieve bed day performance objectives.

• Engage network physicians around performance, costs, clinical appropriateness, and authorization processes.

• Develop UM policies, criteria for authorization review, and forums for physician education.

• Address case management challenges and take part in IDCT Meetings.

• Support physician education on UM and contribute to the establishment of UM goals and objectives.

• Coordinate prospective, concurrent, and retrospective reviews, including the approval or denial of external medical service referrals.

• Create and maintain written medical care protocols, ensuring UM standardization.

• Conduct chart reviews to assess the appropriateness of applying clinical guidelines.

• Act as a physician-to-physician liaison for UM-related matters.

• Prepare and review Decision Validation Criteria as mandated by UM.

• Attend necessary UM, health plan, hospital, and One Altais meetings.

⛳️ Requirements

• Doctor of Medicine degree.

• Valid licensure in California.

• Current Board certification, ideally in a broad-based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery, or Pediatrics.

• At least twelve (12) years of experience as a practicing inpatient and outpatient physician within a managed care setting.

• Active and unrestricted MD licensure in good standing in the state of California.

• External candidates must successfully pass a background check and drug screening.

🏝️ Benefits

• Excellent medical, vision, and dental coverage.

• 401k savings plan with company matching.

• Flexible time off along with 9 paid holidays.

• Eligibility to participate in the annual bonus program.

• Competitive compensation package.

• Comprehensive benefits program.