Medical Director, Utilization & Care Management

Altais; United States; Remote; USD 223,000 - 267,000; Full time

Benefits offered by this job

Excellent medical, vision, and dental

401k with company match

Flexible time off

9 Paid Holidays

Job summary

Altais seeks a Medical Director of Utilization and Medical Management to lead UM policy and collaborate with the Clinical Leadership team across California. The role focuses on ensuring high-quality, cost-effective care within the managed care framework.

Responsibilities include overseeing utilization management, coordinating with PCPs and specialists, and guiding committees. A California MD license and 12+ years in a managed care setting are required, with competitive pay and comprehensive

Qualifications

• MD degree; California medical license; board certification in a broad specialty.
• At least 12 years as practicing inpatient/outpatient physician in managed care.
• Active and in good standing California MD license.

Responsibilities

• Lead UM policy development and procedures with emphasis on utilization and quality management.
• Enhance efficiency and quality of care through network management.
• Collaborate with key providers across One Altais service footprint.
• Co-chair UM/Quality/Peer Review committees as needed.
• Interface with health plans regarding benefits, coverage issues, and appeals.
• Educate PCPs and specialists on utilization management systems.

Skills

MD degree

California licensure

Board certification

Education

Medical degree (MD)

Job description

Altais seeks a Medical Director of Utilization and Medical Management to lead UM policy and collaborate with the Clinical Leadership team across California. The role focuses on ensuring high-quality, cost-effective care within the managed care framework.

Responsibilities include overseeing utilization management, coordinating with PCPs and specialists, and guiding committees. A California MD license and 12+ years in a managed care setting are required, with competitive pay and comprehensive