Medical Director, Prior Authorization & Care Coordination

Physician Pivot; California; On-site; USD 250,000 - 350,000; Full time

Benefits offered by this job

Sign-on bonus

Discretionary awards

CME stipend and paid CME time

Job summary

Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County in Southern California, seeks a Medical Director of Prior Authorization to lead medical necessity reviews and guide pre-service decisions. You will collaborate with physicians and care teams to ensure appropriate, cost-effective care.

The role emphasizes provider relations, quality improvement, and adherence to guidelines across Pomona, Chino, and San Gabriel Valley, with on-site responsibilities and a

Qualifications

• MD degree required; board certification preferred or board-eligible.
• Minimum five years of clinical experience; managed-care or health-plan experience preferred.
• Strong ability to interpret clinical guidelines and apply policies.

Responsibilities

• Review pre-service requests for medical necessity and determine appropriate actions.
• Collaborate with physicians, nurses, and other Medical Directors to deliver cost-effective care.
• Manage provider relations and communicate utilization criteria and documentation expectations.

Skills

MS Office

Communication

Typing 50 wpm

Organizational skills

Project management

Ethics

Stakeholder management

Education

MD degree

Board certification preferred

Tools

Microsoft Office Suite

Job description

Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County in Southern California, seeks a Medical Director of Prior Authorization to lead medical necessity reviews and guide pre-service decisions. You will collaborate with physicians and care teams to ensure appropriate, cost-effective care.

The role emphasizes provider relations, quality improvement, and adherence to guidelines across Pomona, Chino, and San Gabriel Valley, with on-site responsibilities and a