Medical Director, Prior Authorization Leader

Regal-Medical-Grou; California; On-site; USD 250,000 - 350,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

FSA

Life insurance

EAP

CME stipend

Job summary

Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County seeks an experienced Medical Director of Prior Authorization to oversee medical necessity reviews across Pomona, Chino, San Gabriel Valley, and surrounding areas.

The role requires five years of clinical practice with managed-care exposure, strong communication, and collaboration with physicians and staff to ensure access to appropriate care while containing costs.

Qualifications

• MD required with clinical experience.
• Board certification preferred; board eligible acceptable.
• Minimum five years of prior clinical experience; managed-care experience preferred.
• Demonstrated ability to interpret and apply clinical guidelines and organizational policies.
• Excellent communication and teamwork across providers and staff.

Responsibilities

• Prior authorization & medical management reviews for appropriate medical necessity.
• Coordinate with medical directors, nurses, and reviewers to improve care quality and cost-effectiveness.
• Review requests for medical necessity using evidence-based guidelines and policies.
• Identify high-risk patients and coordinate with care teams to reduce unnecessary utilization.
• Engage with primary care physicians and specialists to discuss best practices in patient care and referrals.
• Perform cross-coverage, secondary/tertiary reviews, and director decisions as needed.
• Conduct retroactive claims reviews for outpatient and inpatient care.

Skills

Clinical leadership

Communication skills

Analytical review

Time management

Policy interpretation

Team collaboration

Medical documentation

Education

MD (Doctor of Medicine)

Board certification preferred

Tools

MS Office

Job description

Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County seeks an experienced Medical Director of Prior Authorization to oversee medical necessity reviews across Pomona, Chino, San Gabriel Valley, and surrounding areas.

The role requires five years of clinical practice with managed-care exposure, strong communication, and collaboration with physicians and staff to ensure access to appropriate care while containing costs.