Chief Medical Director, Health Plan Quality & Compliance

Salem Health Hospitals & Clinics; Oxnard (CA); On-site; USD 260,000 - 420,000; Full time

Job summary

Ventura County Health Care Plan (VCHCP) seeks a Medical Director to lead medical services, ensure regulatory compliance, and oversee QA and utilization management. You will chair committees, drive policy interpretation, and steer clinical operations within a licensed HMO framework.

The role requires California board certification, a California medical license, and at least three years in both clinical practice and administration, with strong managed care experience.

Qualifications

• Doctor of Medicine or Osteopathy degree and California medical license.
• Board certification in California and unrestricted practice license.
• Strong knowledge of managed care, QA, UR and peer review programs.

Responsibilities

• Provides overall direction for medical components of VCHCP services.
• Develops and interprets medical policies with stakeholders.
• Leads medical review, credentialing and ongoing QA/UR activities.
• Ensures compliant, safe, cost-conscious care for members.
• Participates in senior management to align clinical and financial goals.

Skills

Regulatory leadership

Quality Assurance

Utilization Review

Peer Review

Committee leadership

Education

MD or DO degree

Job description

Ventura County Health Care Plan (VCHCP) seeks a Medical Director to lead medical services, ensure regulatory compliance, and oversee QA and utilization management. You will chair committees, drive policy interpretation, and steer clinical operations within a licensed HMO framework.

The role requires California board certification, a California medical license, and at least three years in both clinical practice and administration, with strong managed care experience.