Medical Director

Altais Health Solutions; California (MO); Hybrid; USD 223,000 - 267,000; Full time

Benefits offered by this job

Excellent medical, vision, and dental

401k with company match

Flexible time off and 9 paid holidays

Job summary

Altais Health Solutions seeks a Medical Director of Utilization and Medical Management to lead the development and implementation of utilization management policies, ensuring high-quality, efficient care across the continuum. You will collaborate with the Altais Clinical Leadership team and report to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation.

This role requires an MD with California licensure, board certification in a broad-based specialty, and

Qualifications

• Must hold Doctor of Medicine degree and be actively licensed in California.
• Board certification in a relevant specialty preferred.
• Minimum twelve (12) years as practicing inpatient/outpatient physician in a managed care environment.

Responsibilities

• Develop and implement Utilization Management policy and procedures.
• Co-chair UM, Quality Management, Peer Review and Patient Safety committees.
• Interface with health plans on benefits, coverage issues, and appeals.
• Collaborate with physician leaders to manage care cost-effectively without compromising outcomes.
• Lead and educate PCPs and specialists on UM systems and criteria.
• Coordinate prospective, concurrent, retrospective reviews of external medical services.

Skills

Clinical leadership

Utilization management

Quality management

Communication

Education

Doctor of Medicine degree

California medical license

Board certification (MD)

Job description

About Altais

At Altais, we’re on a mission to improve the healthcare experience for everyone - starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.

About the Role

Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with the Altais Clinical Leadership team in ensuring the delivery of high-quality, efficient and comprehensive healthcare services throughout the continuum of care.

This role facilitates and provides information and education for Altais to enable better understanding and skill enhancement in the medical, financial, and utilization practice functions of managed care. You will focus on:

The Medical Director plays a vital role in both the development and implementation of Utilization Management policy and procedures. This physician is chosen based upon their knowledge of medical practice, experience in Managed Care, Utilization, Quality Management programs and an ability to interact well with the other physicians. Works to continually enhance the overall efficiency and quality of care for patients served by One Altais through effective network management.

• Develop and maintain collaborative functioning relationships with key providers, particularly thought leaders, across the One Altais service delivery footprint.
• Provide cooperative leadership and direction to the UMC (Utilization Management Committee) Primary Care Physicians (PCP) and all Specialist Physicians as assigned by the Senior Medical Director.
• Co-chair several committees including the Utilization Management Committee, The Quality Management Committee, the Peer Review and Patient Safety Committee, and others as needed.
• Interface with health plans regarding benefits, coverage issues, response to appeals, attend HMO hearing on appeals and administrative issues which cannot be settled by the Case Managers and/or Management.
• Work closely with physician leaders across all healthcare settings to ensure that patient care is managed in a cost containment manner without compromising health outcomes.
• Facilitate clinical rounds with the Case Managers & Management to ensure bed day performance goals are met.
• Collaborate with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicians with regard to performance, cost, clinical appropriateness and authorizations.
• Take an active role in the development and promotion of managed care systems within One Altais, including development of UM policies and procedures, identifying the type of criteria to be used for authorization review, and implementation of a regular forum in which to educate PCPs and specialists on utilization management systems.
• Serve as an important resource and key contact for identified case management problems and participate in IDCT (Interdisciplinary Care Team) Meetings.
• Support the Senior Medical Director as a resource person for Physician Education on UM and input into the One Altais UM goals and objectives.
• Coordinate prospective, concurrent, retrospective review including denial and/or approval of all outside medical services referrals as necessary.
• Develop and maintain written medical care protocols and assure UM Standardization.
• Conduct Chart Reviews for Appropriateness of applying clinical guidelines.
• Act as Physician to Physician liaison for UM related issues.
• Prepare and review Decision Validation Criteria as required by UM.

Required Meetings:

• UM Committee Health Plan Joint Operations Meetings
• Hospital Joint Operations Meeting
• One Altais Meetings involving Utilization Management

The Skills, Experience & Education You Bring

• Doctor of Medicine degree;
• valid California licensure;
• Current Board certification, preferably in a broad based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics.
• A minimum of twelve (12) years as a practicing inpatient and outpatient physician in a managed care environment.
• Active and in good standing unrestricted MD licensure in the state of California

Compensation and Benefits

The Base Salary for this position is $222,750 - $267,300/year

In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

• Excellent medical, vision, and dental coverage
• 401k savings plan with a company match
• Flexible time off and 9 Paid Holidays

You Share Our Mission & Values

• Compassion: We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.
• Community: We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.
• Leadership: We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.
• Excellence: We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.
• Agility: We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.

Altais values the contribution each Team Member brings to our organization.

Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements.

We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.

All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.

We are dedicated to creating exceptional healthcare experiences by building tools that cultivate the health and well-being of physicians, patients, and the clinical community.