Job description
A well-established Health Plan in southern California is hiring a Medical Director due to growth. The Medical Director will work the with Chief Medical Officer, Quality Assurance Manager and a fellow Physician. This Health Plan and their associated Providers work with multiple hospitals in southern Los Angeles and Orange County. The ideal candidate will be an MD or DO will experience leading a small Health Plan. The Medical Director will work Administratively and may provide patient care in a moon lighting capacity as approved by the Chief Medical Officer.
The Medical Director will take a leading role, with Director of Medical Management, in driving Utilization Management policies, procedures, and operational process improvement. In collaboration with the Manager of Quality Assurance, the Medical Director will assume a significant role in the Health Plan's measured performance in specified incentive programs related to quality, value, and patient care. Components of the Medical Director's position will include:
- Ambulatory referral process
- Clinical decision making
- Operational process improvement
- Management of tertiary and out of network authorization requests
A Medical Director with experience and an understanding of HEDIS, P4P, 5-Stars, VIIP and other payor programs will have a smooth transition into this position. Moreover, experience working with Pediatrics as a Pediatrician is a plus.
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