Medical Director, Clinical Operations

UCLA Health; Los Angeles (CA); Hybrid; USD 123,500 - 302,600; Full time

Job summary

A leading health organization in Los Angeles is seeking a dedicated Medical Director of Clinical Operations to enhance care for Medicare Advantage members. The successful candidate will provide clinical determinations, partner with clinical leaders, and lead UM initiatives. The role requires an MD or DO degree, an active California medical license, and a minimum of 5 years in patient care, preferably with leadership experience. This flexible-hybrid position necessitates one day a week on-site in Los Angeles.

Qualifications

• 5+ years of direct patient care experience post residency.
• 2+ years of experience in Utilization Management.
• Knowledge of Medicare Advantage and case management.

Responsibilities

• Provide clinical determinations for UM including prior authorizations.
• Partner with clinical leaders to ensure high-quality care.
• Collaborate with Pharmacy team on medication use.

Skills

Leadership

Clinical Determinations

Communication Skills

Strategic Thinking

Proficiency in EMR

Education

MD or DO degree

Active California State Medical License

Residency in Primary Care

Board Certification in Internal or Family Medicine

Tools

Health plan platforms

Job 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.

We’re seeking a dynamic and strategic individual with

• MD or DO degree
• Active, unrestricted California State Medical License
• Completion of residency in an adult-based primary care specialty (e.g., Internal Medicine, Family Medicine, Geriatrics)
• Board Certification in an ABMS, ABOS, or AOA-recognized specialty (preferably Internal Medicine or Family Medicine)
• 5 or more years of direct patient care experience post residency
• 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

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.