Senior Physician Reviewer – Utilization & Appeals

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 206,000 - 351,000; Full time

Benefits offered by this job

Paid Sick Leave

457 (b) Retirement Plan

529 College Savings Plan

Job summary

L.A. Care Health Plan in Los Angeles invites a Physician Reviewer II to conduct medical reviews and provide clinical consultation under the Senior Medical Director. The role emphasizes utilization management, approvals, and coordinating with care teams.

The position requires an MD, California license, leadership abilities, and experience with safety-net populations. You will contribute to quality care and regulatory compliance within a large public health plan.

Qualifications

• MD degree required and California medical license active and unrestricted.
• Experience leading physicians, nurses and health care professionals.
• Experience with Medicaid managed care and safety net populations preferred.

Responsibilities

• Conduct medical reviews and prepare determinations on utilization management, pharmacy, and prior authorizations.
• Provide clinical consultation to case management staff and other L.A. Care staff.
• Review data to improve Medical Management programs and processes.
• Participate in Concurrent Review and Interdisciplinary Care Team rounds and regulatory compliance activities.

Skills

Leadership

Teamwork

Communication

Collaboration

Education

Doctor of Medicine (M.D.)

Job description

L.A. Care Health Plan in Los Angeles invites a Physician Reviewer II to conduct medical reviews and provide clinical consultation under the Senior Medical Director. The role emphasizes utilization management, approvals, and coordinating with care teams.

The position requires an MD, California license, leadership abilities, and experience with safety-net populations. You will contribute to quality care and regulatory compliance within a large public health plan.