Associate Medical Director / Medical Director
- Full-time
Monday – Friday, 8 : 00am – 5 : 00pm PST; additional weekends and holiday coverage prn as business needs arise
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.
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.
Contribute to interdisciplinary care team rounds for complex case management.
Serve as clinical SME for network / provider relations and present at provider education sessions.
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
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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