Associate Medical Director
- serp_jobs.job_card.full_time
Description
Are you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan.
In this key leadership role, you'll work closely with the UHMAP Medical Director and play a vital part in developing and guiding clinical policy that's grounded in the latest scientific research and Medicare guidelines. Your work will directly support our Health Services Department in delivering high-quality, appropriate, and patient-centered care.
What you'll do :
Lead the development, implementation, and training of medical policies.
Provide clinical determinations for UM (prior authorizations, concurrent reviews, appeals, grievances, peer-to-peer).
Support day-to-day UM and Clinical Appeals operations.
Partner with clinical and operational leaders to ensure high-quality, cost-effective care.
Collaborate with the Pharmacy team on safe, effective medication use; participate in drug review rounds and P&T Committee.
Contribute to interdisciplinary care team rounds for complex case management.
Serve as clinical SME for network / provider relations and present at provider education sessions.
Salary Range : $123,500-302,600 / annually
Note : This position is a flexible-hybrid role that requires one-day a week on-site in Los Angeles, CA
Qualifications
We're seeking a dynamic and strategic individual with :
- MD or DO degree, required
Active, unrestricted California State Medical
License, required
Completion of residency in an adult-based
primary care specialty (e.g., Internal Medicine, Family Medicine, Geriatrics),
required
Board Certification in an ABMS, ABOS, or
AOA-recognized specialty (preferably Internal Medicine or Family Medicine),
required
5 or more years of direct patient care
experience post residency, required
Minimum of 2 years medical leadership
experience, required
Minimum of 2 years of experience in Utilization
Management, required
Minimum of 2 years in developing evidence-based
guidelines, medical policies, or conducting systematic literature review, highly desired
Familiarity with evidence-based guidelines,
MCG / InterQual, and ICD / CPT coding, preferred
Experience with population health and CMS STAR
ratings, preferred
Ability to lead and influence in a matrixed
organizational structure
Mastery of clinical policy development and
application
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