Associate Medical Director

1 week ago

Los Angeles, California, United States UCLA Health Full time $123,500 - $302,600 per year

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

Note: This position is a flexible-hybrid role that requires one-day a week on-site in Los Angeles, CA.

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
  • 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
  • Minimum of 2 years in developing evidence-based guidelines, medical policies, or conducting systematic literature review, highly desired
  • 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
  • Strong verbal and written communication skills
  • Proficiency in EMR, health plan platforms and productivity tools
  • High integrity and commitment to ethical medical practice

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