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Posted: 19-Oct-25
Location: Los Angeles, California
Categories:
Internal Number: 149482965
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.
We’re seeking a dynamic and strategic individual with:
- 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
- Minimum of 2 years in developing evidence-based guidelines, medical policies, or conducting systematic literature review, 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
- 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
- Mastery of clinical policy development and application
