Associate Medical Director

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