Medical Director, Clinical Operations (NCHP)
- [job_card.full_time]
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 Medical Director, Clinical Operations to help shape the future of our plan.
In this key leadership role, you'll work closely with the Medical Director, Department of Health Services and play a vital part in scaling Health Services functions. Your work will directly support our Health Services Department in delivering high-quality, appropriate, and patient-centered care.
What you'll do :
Provide clinical determinations for UM (prior authorizations, concurrent reviews, appeals, grievances, peer-to-peer).
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.
The UCLA Health salary range for this title code is $123,500-$302,600 / annually. Please note that the department's target pay range is $250,000- $300,000 / 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 :
Required :
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 of experience in Utilization Management
2 or more years of experience working managed care
Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case management
Ability to lead and influence in a matrixed organizational structure
Strong verbal and written communication skills
Strategic thinker with a collaborative, team-oriented approach
Proficiency in EMR, health plan platforms and productivity tools
High integrity and commitment to ethical medical practice
Preferred :
Minimum of 2 years medical leadership
experience
Familiarity with evidence-based guidelines,NCD,LCD, MCG, and ICD / CPT coding
Experience with population health and CMS STAR
ratings
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