Description
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
Qualifications
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
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University of California - Los Angeles Health
Sep 18, 2025