University of California
Associate Medical Director
University of California, Los Angeles, California, United States, 90079
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
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, required 2 or more years of experience working within a health plan, required Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case management, required 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
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
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, required 2 or more years of experience working within a health plan, required Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case management, required 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