Medical Director - Utilization Management (MD/DO) – Part Time

Mascmedical; California; On-site; USD 192,000 - 261,000; Part time

Job summary

MASC Medical is recruiting a part-time Medical Director of Utilization Management for a San Diego PACE program serving frail, dual-eligible older adults. This 20-hour-a-week leadership role has no patient panel or on-call duties, and you will own medical necessity determinations across outpatient, inpatient, and post-acute settings.

You will lead peer-to-peer discussions, oversee the appeals process under CMS, Medi-Cal, and PACE requirements, and collaborate with interdisciplinary teams to drive

Qualifications

• Active, unrestricted California MD or DO license.
• Active DEA registration.
• Current BLS.
• Board certified or board eligible in a primary care specialty.
• 5+ years of clinical practice in Internal Medicine, Geriatrics, and/or Family Medicine.
• 3+ years in utilization/resource management or medical leadership within managed care, a health plan, or a value-based care setting.
• Working command of Medicare and Medicaid/Medi-Cal regulations and CMS coverage criteria.
• Experience applying evidence-based UM guidelines (InterQual preferred; MCG acceptable).

Responsibilities

• Make and direct medical necessity determinations for outpatient, inpatient, and post-acute care (SNF, ALF, LTACH, palliative, hospice, home health).
• Apply InterQual and CMS coverage criteria; own the standards and train the team on how to use them.
• Lead peer-to-peer discussions with site medical directors, PCPs, and external network and non-contracted providers.
• Serve as physician reviewer on escalated and complex utilization cases.
• Lead and protect the integrity of the appeals and grievance process under CMS, Medi-Cal, and PACE requirements.
• Support authorization review, concurrent review, and denial management alongside nurse UM specialists.
• Monitor for over- and under-utilization; spot patterns driving avoidable admissions and length-of-stay.
• Provide oversight of HCC/ICD-10 diagnosis coding and RAF accuracy.
• Develop medical policy and drive evidence-based clinical guideline adoption.
• Partner with the CMO, Behavioral Health Director, Health Plan Director, and interdisciplinary teams.
• Chair or sit on committees including credentialing and P&T.
• Document to PACE, NCQA, and CMS standards and support audit readiness.

Skills

Utilization management

Clinical leadership

CMS/Medi-Cal knowledge

InterQual guidelines

Policy development

Peer discussions

Education

California MD or DO license

DEA registration

BLS certification

Board certification or eligibility (primary care)

5+ years clinical practice (Internal Medicine/Geriatrics/Family Medicine)

3+ years in utilization/resource management or medical leadership

Tools

InterQual/MCG guidelines

Job description

San Diego, United States

Pay: $139.23 – $189.38 per hour — roughly $145,000–$197,000 a year for a 20-hour week Schedule: Part-time, 20 hours per week Location: San Diego, CA License: Active, unrestricted California MD or DO + DEA + BLS

MASC Medical is recruiting a part-time Medical Director of Utilization Management for a San Diego PACE program (Program of All-Inclusive Care for the Elderly) serving frail, dual-eligible older adults.

This is a 20-hour-a-week physician leadership role with no patient panel and no call. You'd own medical necessity determinations across outpatient, inpatient, and post-acute settings, run peer-to-peer conversations, and lead the appeals process — the clinical judgment part of the job, without the RVU treadmill. It's built for an internist or geriatrician who has done the clinical years and wants to influence how care gets delivered for a whole population instead of one patient at a time.

What you'll do

Make and direct medical necessity determinations for outpatient, inpatient, and post-acute care (SNF, ALF, LTACH, palliative, hospice, home health)

Apply InterQual and CMS coverage criteria; own the standards and train the team on how to use them

Lead peer-to-peer discussions with site medical directors, PCPs, and external network and non-contracted providers

Serve as physician reviewer on escalated and complex utilization cases

Lead and protect the integrity of the appeals and grievance process under CMS, Medi-Cal, and PACE requirements

Support authorization review, concurrent review, and denial management alongside nurse UM specialists

Monitor for over- and under-utilization; spot patterns driving avoidable admissions and length-of-stay

Provide oversight of HCC/ICD-10 diagnosis coding and RAF accuracy

Develop medical policy and drive evidence-based clinical guideline adoption

Partner with the CMO, Behavioral Health Director, Health Plan Director, and interdisciplinary teams

Chair or sit on committees including credentialing and P&T

Document to PACE, NCQA, and CMS standards and support audit readiness

What you'll need

Must have

Active, unrestricted California MD or DO license

Active DEA registration

Current BLS

Board certified or board eligible in a primary care specialty

5+ years of clinical practice in Internal Medicine, Geriatrics, and/or Family Medicine

3+ years in utilization/resource management or medical leadership within managed care, a health plan, or a value-based care setting

Working command of Medicare and Medicaid/Medi-Cal regulations and CMS coverage criteria

Experience applying evidence-based UM guidelines (InterQual preferred; MCG acceptable)

Nice to have

PACE clinical or PACE utilization management experience

Advanced degree — MPH, MHA, MBA, or MS

ACLS

Epic and QuickCap familiarity

Why physicians take this role

$139–$189/hour — top of market for part-time physician UM work in Southern California

20 hours a week. Genuinely part-time, not a full-time job priced hourly.

No patient panel, no call, no productivity targets

Real authority: you set the criteria, chair the committees, and own the appeals process

Population-level impact on a frail, dual-eligible senior population where good UM decisions visibly change outcomes

Works alongside continued clinical practice, a teaching role, or a phased wind-down