Make a difference in people’s lives every day. When you join UCLA Health, you’ll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of them plays a vital role in our commitment to care.
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
EMPLOYMENT SCAM ALERT:
UCLA Health Recruitment is currently being targeted by scam artists through external job board sites. Review some tips in order to avoid becoming targeted. El reclutamiento de salud de UCLA actualmente está siendo atacado por estafadores a través de sitios de juntas de trabajo externos. Revisar algunos consejos para evitar ser apuntado.
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VINCENT, Sr. CLS Specialist, Toxicology
MONICA
I've been blessed to touch so many lives through my serving. It's a privilege to uplift other employees with words of encouragement and a smile.
SOZIT
The first thing i noticed when i joined the team was how everyone is very welcoming and friendly with supportive management. I did not feel like an outsider.
EDGAR
Once I joined, I knew UCLA Health was THE place to be due to the growth potential and training offered
RENE
If you want to grow professionally, this is the right place for you.
ERA
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ELIZABETH
It’s so diverse and inclusive here. There’s always the opportunity to share your thoughts. It's a place where you feel you belong.
JERRY
Your career path at UCLA Health will enable you to follow a myriad of avenues and turns. It opens up a wide variety of opportunities.
ORLANDO
There’s a togetherness and higher level of commitment to teamwork at UCLA Health. We are several groups and teams that work together with a common goal which is to improve our patients experience.
DAVID
UCLA Health walks the walk and talks the talk! It's an incredible feeling to work for an organization that always puts the patient first. I am honored to work in full alignment with the UCLA Health Mission and Vision.
DR. ISLA GARRAWAY
UCLA has incredible resources and a team science approach. The ability to work with collaborative teams and access the amazing resources around campus is the best part about being at UCLA.
RADU
UCLA is very diverse in its personnel as well as its many research fields studied
JENNA
UCLA Health provides so many opportunities to exchange ideas, share moments and grow. I have learned a lot about team management and relationship building.
SHARON
I was looking for a job to further my career and continue to improve and learn as a therapist.
TARO
I have been blessed to be surrounded by supportive colleagues who aspire me to be the best version of myself.
Awards & recognition
