Based in Cerritos, CA, the Medical Directorwill oversee the administration of physical and/or behavioral health medicalservices, ensuring that patients receive appropriate and cost-effective medicalcare. This role includes developing and implementing programs to improvequality, cost, and clinical outcomes, providing strategic consultation, andidentifying opportunities for innovation.
The Medical Director may also lead clinicalprograms, offer clinical guidance, and serve as a consultant and resource toboth internal teams and external partners.
Compensation & Benefits:$263,488 - $395,232 plus excellent benefits package
Primary Responsibilities:
- Support clinicians to ensure timely andconsistent responses to members and providers.
- Chart Review, Provide guidance on clinicaloperational aspects of programs.
- Conduct peer-to-peer clinical reviews withattending physicians or other providers regarding review determinations andpatient visits.
- Represent the organization to externalentities and serve on internal or external committees.
- Interpret and propose updates to medicalpolicies and clinical guidelines based on healthcare changes.
- Lead, develop, and implement clinical andnon-clinical initiatives that impact healthcare quality, cost, and outcomes.
- Identify and develop innovative opportunitiesto enhance effectiveness and quality.
- Full Time, Call 1:4
Requirements:
- MD or DO with Board certification approved bythe American Board of Medical Specialties or American Osteopathic Association.
- Active, unrestricted medical license topractice medicine in the U.S.
- Minimum of 10 years of clinical experience.
- At least 5 years of experience providinghealthcare, with additional experience as required by state contracts orregulations.
- Strong oral, written, and interpersonalcommunication skills, as well as problem-solving, facilitation, and analyticalcapabilities.
Additional Requirements:
- Must reside within a U.S. state or territoryand not on a military base, vessel, or embassy for utilization review orappeals considerations.
- For URAC-accredited areas, professionalcompetencies in communication, facilitation, and analytics are essential.
This position offers a competitivecompensation range, opportunities for professional growth, and the chance tolead impactful healthcare initiatives.
