Medicare Advantage Medical Director, Clinical Ops

UCLA Health; Los Angeles (CA); Hybride; USD 123 500 - 302 600; Plein temps

Résumé du poste

A leading health organization in Los Angeles is seeking a dedicated Medical Director of Clinical Operations to enhance care for Medicare Advantage members. The successful candidate will provide clinical determinations, partner with clinical leaders, and lead UM initiatives. The role requires an MD or DO degree, an active California medical license, and a minimum of 5 years in patient care, preferably with leadership experience. This flexible-hybrid position necessitates one day a week on-site in Los Angeles.

Qualifications

• 5+ years of direct patient care experience post residency.
• 2+ years of experience in Utilization Management.
• Knowledge of Medicare Advantage and case management.

Responsabilités

• Provide clinical determinations for UM including prior authorizations.
• Partner with clinical leaders to ensure high-quality care.
• Collaborate with Pharmacy team on medication use.

Connaissances

Leadership

Clinical Determinations

Communication Skills

Strategic Thinking

Proficiency in EMR

Formation

MD or DO degree

Active California State Medical License

Residency in Primary Care

Board Certification in Internal or Family Medicine

Outils

Health plan platforms

Description du poste

A leading health organization in Los Angeles is seeking a dedicated Medical Director of Clinical Operations to enhance care for Medicare Advantage members. The successful candidate will provide clinical determinations, partner with clinical leaders, and lead UM initiatives. The role requires an MD or DO degree, an active California medical license, and a minimum of 5 years in patient care, preferably with leadership experience. This flexible-hybrid position necessitates one day a week on-site in Los Angeles.