Medical Director, Utilization & Quality Leadership

Altais Health Solutions; California (MO); Hybrid; USD 223,000 - 267,000; Full time

Benefits offered by this job

Excellent medical, vision, and dental

401k with company match

Flexible time off and 9 paid holidays

Job summary

Altais Health Solutions seeks a Medical Director of Utilization and Medical Management to lead the development and implementation of utilization management policies, ensuring high-quality, efficient care across the continuum. You will collaborate with the Altais Clinical Leadership team and report to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation.

This role requires an MD with California licensure, board certification in a broad-based specialty, and

Qualifications

• Must hold Doctor of Medicine degree and be actively licensed in California.
• Board certification in a relevant specialty preferred.
• Minimum twelve (12) years as practicing inpatient/outpatient physician in a managed care environment.

Responsibilities

• Develop and implement Utilization Management policy and procedures.
• Co-chair UM, Quality Management, Peer Review and Patient Safety committees.
• Interface with health plans on benefits, coverage issues, and appeals.
• Collaborate with physician leaders to manage care cost-effectively without compromising outcomes.
• Lead and educate PCPs and specialists on UM systems and criteria.
• Coordinate prospective, concurrent, retrospective reviews of external medical services.

Skills

Clinical leadership

Utilization management

Quality management

Communication

Education

Doctor of Medicine degree

California medical license

Board certification (MD)

Job description

Altais Health Solutions seeks a Medical Director of Utilization and Medical Management to lead the development and implementation of utilization management policies, ensuring high-quality, efficient care across the continuum. You will collaborate with the Altais Clinical Leadership team and report to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation.

This role requires an MD with California licensure, board certification in a broad-based specialty, and