Associate Medical Director

UCLA Health • Los Angeles, CA

50d • $123,500 - $302,600 • Hybrid

About The Position

Are you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. 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. What 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 sessions.

Requirements

• MD or DO degree, required
• Active, unrestricted California State Medical License, required
• Completion of residency in an adult-based primary care specialty (e.g., Internal Medicine, Family Medicine, Geriatrics), required
• Board Certification in an ABMS, ABOS, or AOA-recognized specialty (preferably Internal Medicine or Family Medicine), required
• 5 or more years of direct patient care experience post residency, required
• Minimum of 2 years medical leadership experience, required
• Minimum of 2 years of experience in Utilization Management, required
• 2 or more years of experience working within a health plan, required
• Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case management, required
• Mastery of clinical policy development and application
• Strong verbal and written communication skills
• Proficiency in EMR, health plan platforms and productivity tools
• High integrity and commitment to ethical medical practice

Nice To Haves

• Minimum of 2 years in developing evidence-based guidelines, medical policies, or conducting systematic literature review, highly desired
• Familiarity with evidence-based guidelines, MCG/InterQual, and ICD/CPT coding, preferred
• Experience with population health and CMS STAR ratings, preferred
• Ability to lead and influence in a matrixed organizational structure

Responsibilities

• 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 sessions.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Hospitals
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees