Associate Medical Director

OverviewAre you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our UCLA Health Medicare Advantage Plan (UHMAP).In this key leadership role, you’ll work closely with the UHMAP Medical Director and play a vital part in developing and guiding clinical policy that’s grounded in the latest scientific research and Medicare guidelines. Your work will directly support our Health Services Department in delivering high-quality, appropriate, and patient-centered care.ResponsibilitiesWhat you’ll do:Lead the development, implementation, and training of medical policies.Provide clinical determinations for UM (prior authorizations, concurrent reviews, appeals, grievances, peer-to-peer).Support day-to-day UM and Clinical Appeals operations.Partner with clinical and operational leaders to ensure high-quality, cost-effective care.Collaborate with the Pharmacy team on safe, effective medication use; participate in drug review rounds and P&T Committee.Contribute to interdisciplinary care team rounds for complex case management.Serve as clinical SME for network/provider relations and present at provider education pensation: Salary Range: $123,500-302,600/annuallyQualificationsWe’re seeking a dynamic and strategic individual with:MD or DO degree, requiredActive, unrestricted California State Medical License, requiredCompletion of residency in an adult-based primary care specialty (e.g., Internal Medicine, Family Medicine, Geriatrics), requiredBoard Certification in an ABMS, ABOS, or AOA-recognized specialty (preferably Internal Medicine or Family Medicine), required5 or more years of direct patient care experience post residency, requiredMinimum of 2 years medical leadership experience, requiredMinimum of 2 years of experience in Utilization Management, requiredMinimum of 2 years in developing evidence-based guidelines, medical policies, or conducting systematic literature review, required2 or more years of experience working within a health plan, requiredKnowledge of Medicare Advantage experience with utilization management, quality improvement, or case management, requiredFamiliarity with evidence-based guidelines, MCG/InterQual, and ICD/CPT coding, preferredExperience with population health and CMS STAR ratings, preferredAbility to lead and influence in a matrixed organizational structureMastery of clinical policy development and application #J-18808-Ljbffr

Created: 2025-10-06