Associate Medical Director na UCLA Health

Are 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.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.Salary Range: $123,500-302,600/annually Candidatar-se agora