Medical Director, Medical Management
1 month ago
Salary Range: $206,311.00 (Min.) - $278,520.00 (Mid.) - $350,729.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Medical Director, Medical Management, is responsible for performing and overseeing the quality assurance of the daily clinical operational functions and traditional medical management services of the organization. These consist of but not limited to prior authorization and retro review, concurrent review (hospital, Skilled Nursing Facility (SNF), Long Term Care (LTC), etc.), conducting daily hospital rounds and discharge planning, transitions of care, complex care rounds, interdisciplinary care team rounds, appeals and grievances and provider disputes. On day to day level, the Medical Director needs to work closely with the various Health Services departmental leaders and others to ensure that 1) all various day-to-day L.A. Care clinical operations are performed in a timely and regulatory compliant manner, adhering to the highest standards of evidence-based care; 2) units/programs effectiveness are met and; 3) operational processes are constantly monitored and optimized and 4) daily work performed is tracked, appropriately audited and reviewed for ongoing team education and improvement.
This position works collaboratively with internal and external key stakeholders in providing medical leadership and clinical input for the successful delivery, improvement and development of member and provider services as well as ensure regulatory compliance as well as reduce administrative costs and burden to meet L.A. Care members’ health needs, enable providers to provide effective and quality care and achieve organizational goals and objectives. External stakeholders may include providers, medical groups, hospitals, mental health, substance use, social services providers, and regulatory organizations.
DutiesEnsure all accreditation, regulatory, clinical operational and documentation standards and reporting needs are met.
Perform clinical review of prospective, concurrent, and retrospective reviews.
Participate in the creation of authorization rules.
Review and participate in monitoring of staff performance.
Monitor processes and ensure that team objectives are met.
Support a culture and environment that reinforces continuously administrative efficiencies and improvements.
Serve as a clinical resource to both non-clinical and clinical staff and contracted delegates.
Participate on call coverage.
Perform daily care management functions including care team rounds.
Review of appeals, grievances and provider disputes.
Provide strategic and operational leadership with the creation and implementation of a regional UM model.
Duties ContinuedProvide clinical and policy expertise for relevant programs, projects, vendors, new technology) and benefit reviews.
Interact and build productive and collaborative relationships with external stakeholders (i.e. medical groups, hospitals, hospitalists, community based providers and social service providers).
Manage team-specific and/or departmental projects, as assigned by leadership.
Provide input on relevant clinical services areas as it relates to public and community based communications, root cause analysis and corrective actions.
Support and interpret of relevant data and metrics.
Assist with development, review, and implementation of policies and procedures to ensure that all work of the department meets all regulatory and accrediting standards for all products.
Chair or facilitate committees or meetings, as assigned by leadership.
Perform other duties as assigned.
Education Required Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.)Education Preferred ExperienceRequired:
Minimum of 8 years experience in clinical practice post-residency.
Preferred:
Prior experience in medical management or physician advisory roles
Experience with Medicaid managed care and/or other governmental programs for underserved, safety net populations including women, children, persons with disabilities, seniors, and those of ethnic and cultural backgrounds
Experience in National Committee for Quality Assurance (NCQA) accreditation, Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC) audits.
Experience with health information technology, data analytics and process improvement.
SkillsRequired:
Ability to provide leadership to physicians, nurses, and other health care professionals, and an interest and involvement in the affairs of the health care community.
Demonstrated ability for teamwork and collaborative problem-solving.
Excellent written and verbal communication skills, negotiating skills, consensus building and teamwork, planning and implementation skills.
Knowledge with Medicare and Medicare-Medicaid.
Familiarity with Federal programs such as Medi-Cal, Medicare and Covered California.
Licenses/Certifications Required Physician License to practice in California - active, current and unrestricted California LicenseBoard Certified, preferably in a primary or medical specialty - Active, current and unrestricted California license.Licenses/Certifications Preferred Required Training Physical Requirements LightAdditional InformationNo history of disciplinary action by State Medical Board.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
-
Associate Medical Director
3 weeks ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob Description MedPOINT Management (MPM)Department: Utilization Management (UM)Title Associate Medical Director SummaryThe Associate Medical Director is responsible for providing medical interpretation and decisions about appropriateness of services provided by other healthcare professionals in compliance with Utilization Management...
-
Associate Medical Director
2 weeks ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob Description MedPOINT Management (MPM)Department: Utilization Management (UM)Title Associate Medical Director SummaryThe Associate Medical Director is responsible for providing medical interpretation and decisions about appropriateness of services provided by other healthcare professionals in compliance with Utilization Management...
-
Director Nursing Medical Surgical
7 days ago
Los Angeles, United States California Hospital Medical Center Full time**Overview** If you are committed to social justice, health equity, and prepared to deliver care in new, innovative ways, you belong with us. We offer the following benefits to support you and your family: - Relocation Assistance. - Annual Incentive (Bonus) Program. - Matching Retirement Program. - Pension fully funded by the Hospital. - Tuition...
-
Los Angeles, United States Clinical Management Consultants Full timeAn exceptional centrally located hospital in Los Angeles is seeking an experienced Nurse Director to lead the inpatient Medical, Surgical and Telemetry unit. The Nurse Director will oversee all clinical operations and management of these high-acuity Director, Nurse, Clinical, Surgical, Medical, Telemetry, Healthcare
-
Regional Medical Director
3 weeks ago
Los Angeles, United States Altamed Health Services Corp Full timeRegional Medical Director page is loaded Regional Medical Director Apply remote type In Person locations Commerce, CA 90040 time type Full time posted on Posted 3 Days Ago job requisition id 2024-0138-P Work Boldly. Live Brilliantly.At AltaMed, we don’t just serve our communities, we are part of them. We have...
-
Regional Medical Director
2 weeks ago
Los Angeles, United States AltaMed Health Services Corporation Full timeWork Boldly. Live Brilliantly.At AltaMed, we don't just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It's the calling of our lives and it compels us...
-
Medical Director
6 days ago
Los Angeles, United States MedCentric Full timeJob DescriptionJob DescriptionPACE Medical DirectorAbout the Company:We are a quickly growing organization committed to providing the highest quality, cost-effective care for our PACE program participants. Our focus is on managing chronic illnesses in elderly patients by emphasizing preventative care. We believe in a patient-centered approach, keeping our...
-
Medical Director
1 week ago
Los Angeles, United States MedCentric Full timeJob DescriptionJob DescriptionPACE Medical DirectorAbout the Company:We are a quickly growing organization committed to providing the highest quality, cost-effective care for our PACE program participants. Our focus is on managing chronic illnesses in elderly patients by emphasizing preventative care. We believe in a patient-centered approach, keeping our...
-
Medical Director
3 days ago
Los Angeles, United States Potentia Search Full timePotentia Search are currently partnered with a leading Veterinary Group looking to hire a Medical Director to oversee a fully-staffed Veterinary Practice. Responsibilites: Oversee the medical operations, ensuring the highest quality of care Provide training and mentorship Build relationships with the referring community Requirements: Doctor of Veterinary...
-
Medical Assistant
1 week ago
Los Angeles, United States Medical Professionals Full timeDo you have a passion for helping patients and providing them with the care and education they need? If you answered yes, then this may be the job for you! Our office is looking to hire an experienced *Medical Assistant* to join our growing team!*Job Duties:** Greet patients, assist with forms, schedule appointments, retrieve medical files, maintain medical...
-
Medical Assistant
22 hours ago
Los Angeles, United States Medical Professionals Full timeDo you have a passion for helping patients and providing them with the care and education they need? If you answered yes, then this may be the job for you! Our office is looking to hire an experienced *Medical Assistant* to join our growing team!*Job Duties:** Greet patients, assist with forms, schedule appointments, retrieve medical files, maintain medical...
-
Medical Director
2 weeks ago
Los Angeles, United States Barrington James Full timeFantastic new opportunity for a enthusiastic Medical Director with significant experience in Clinical Development. Candidate requirements: Medically trained oncologist. 6 years of experience in the pharmaceutical industry with a track record in all phases of development. Deep understanding of the related disciplines from; biostatistics, regulatory,...
-
Medical Planning Director
2 weeks ago
Los Angeles, United States NBBJ Full timeNBBJ is seeking a Medical Planning Director with experience in the design and planning of complex healthcare environments including large-scale hospitals and ambulatory care centers. Why this role is important to NBBJ:This is an opportunity to join a Director, Medical, Planning, Healthcare, Designer
-
Medical Spa Manager Patient Liason
5 days ago
Los Angeles, United States BATAL MEDICAL, INC Full timeWe are looking for a Medical Spa Manager Patient Liason to work with us either full time, part time, or contractually.We are a cosmetic surgery service but are looking to break into the med spa space. Requirements: 1 Bachelor's degree in business administration, healthcare management, or a related field is preferred, but not required. 2 Prior experience in...
-
Medical Spa Manager Patient Liason
6 days ago
Los Angeles, United States BATAL MEDICAL, INC Full timeWe are looking for a Medical Spa Manager Patient Liason to work with us either full time, part time, or contractually.We are a cosmetic surgery service but are looking to break into the med spa space. Requirements: 1 Bachelor's degree in business administration, healthcare management, or a related field is preferred, but not required. 2 Prior experience in...
-
Medical Spa Manager Patient Liason
6 days ago
Los Angeles, United States BATAL MEDICAL, INC Full timeWe are looking for a Medical Spa Manager Patient Liason to work with us either full time, part time, or contractually.We are a cosmetic surgery service but are looking to break into the med spa space. Requirements: 1 Bachelor's degree in business administration, healthcare management, or a related field is preferred, but not required. 2 Prior experience in...
-
Medical Receptionist
7 days ago
Los Angeles, United States Medical Professionals Full timeAre you looking to work for an orthopedic practice that truly invests in the well-being of their patients? We are a well-established group with over 20 locations seeking an experienced *Medical Receptionist* to join our office! We have a solid history within the communities we service. We also take care of our employees by providing promotions from within,...
-
Medical Office Manager
2 days ago
Los Angeles, United States Perlow Medical Corporation Full timeJob DescriptionJob Description SUMMARY STATEMENTThe Office Manager at our OBGYN Clinical Private Practice is responsible for overseeing the day-to-day administrative functions of the clinic, ensuring smooth and efficient operations, and providing the highest level of patient care and service. TYPE OF SUPERVISION RECEIVEDThe Office Manager will work under...
-
Medical Director of Population Health
24 hours ago
Los Angeles, United States UCLA Health Full timeThe Medical Director of Population Health is a member of the senior leadership team of the UCLA Health Faculty Practice Group (FPG). Under the direction of the FPG CMO, the Medical Director of Population Health works in a dyad relationship with the D Medical Director, Director, Health, Medical, Healthcare, Practice
-
Medical Bioethics Director
2 weeks ago
Los Angeles, United States Kaiser Permanente Full timeJob Summary: The Bioethics Program Director provides leadership and oversight for the Medical Centers Bioethics Program, including healthcare ethics consultation, policy development, organizational ethics quality activities, and ethics education. The Bioethics Program Director promotes and sustains ethical considerations into the Medical Center environment...
