Direct Jobs
Overview
Are you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our UCLA Health Medicare Advantage Plan (UHMAP).
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.
Responsibilities
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
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
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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.
Responsibilities
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
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
#J-18808-Ljbffr