Medical Director – Casual

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

📋 Description

• Report directly to the Senior Medical Director, with a dotted line reporting to the Chief Officer for Health and Innovation.

• Assist in the provision of high-quality, efficient, and comprehensive healthcare services across the entire continuum of care.

• Create and execute Utilization Management policies and procedures.

• Improve patient care efficiency and quality through effective network management strategies.

• Cultivate and sustain collaborative relationships with essential providers and physician thought leaders.

• Offer leadership and guidance to the Utilization Management Committee, including primary care and specialist physicians.

• Co-chair various committees, such as Utilization Management, Quality Management, Peer Review, and Patient Safety, as required.

• Collaborate with health plans on benefits, coverage matters, appeals, HMO hearings, and unresolved administrative concerns.

• Oversee patient care in a cost-effective manner while maintaining health outcome standards.

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

• Engage network physicians regarding performance metrics, costs, clinical appropriateness, and authorizations.

• Develop and advocate for managed care systems within One Altais.

• Identify criteria for authorization review and educate primary and specialist physicians on utilization management systems.

• Act as a resource for case management challenges and participate in Interdisciplinary Care Team meetings.

• Support physician education relating to Utilization Management and contribute to UM goals and objectives.

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

• Draft and maintain written medical-care protocols, ensuring standardization in Utilization Management.

• Conduct chart reviews to assess the appropriateness of clinical guideline applications.

• Serve as a physician-to-physician liaison for Utilization Management matters.

• Prepare and evaluate Decision Validation Criteria as mandated by Utilization Management.

• Attend necessary meetings for UM Committee, Health Plan Joint Operations, Hospital Joint Operations, and One Altais.

⛳️ Requirements

• Doctor of Medicine degree.

• Valid California medical license.

• 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 physician in both inpatient and outpatient settings within a managed care environment.

• A demonstrated interest and experience in utilization management and medical management.

• Ability to operate during business hours on Pacific Standard Time.

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

🏝️ Benefits

• Outstanding medical, vision, and dental coverage.

• 401k savings plan with company matching.

• Flexible time off policy.

• 9 Paid Holidays.

• Competitive compensation package.

• Background check and drug screening required for external hires.