UCLA Health
Overview
Join to apply for the
Associate Medical Director
role at
UCLA Health . This range is provided by UCLA Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$123,500.00/yr - $302,600.00/yr 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. 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 Job details
Seniority level: Associate Employment type: Full-time Job function: Health Care Provider Industry: Hospitals and Health Care
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Join to apply for the
Associate Medical Director
role at
UCLA Health . This range is provided by UCLA Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$123,500.00/yr - $302,600.00/yr 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. 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 Job details
Seniority level: Associate Employment type: Full-time Job function: Health Care Provider Industry: Hospitals and Health Care
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