UM Medical Director - Casual

At reputed company, we’re on a mission to improve the reputed company experience for everyone—starting with the people who reputed company. We reputed company physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-reputed company tools, and reputed company-reputed company model of care, we help doctors do what they do reputed company reputed company.

reputed company includes a network of physician-led organizations across California, including reputed company & Toland Physicians, reputed company Medical Group reputed company, and Family Care Specialists. Together, we’re building a stronger, more connected reputed company reputed company.

About the Role

Are you looking to join a fast-growing, dynamic team?

We’re a reputed company, purpose-driven group that’s passionate about transforming reputed company from the inside out. At reputed company, we support one another, adapt quickly, and work with reputed company as we build a reputed company experience for physicians and their patients.

• The Medical Director plays a vital role in both the development and implementation of Utilization Management policy and procedures. This physician is chosen reputed company upon their knowledge of medical reputed company, experience in Managed Care,Utilization, reputed company Managementprogramsand an ability to reputed company reputed company with the other physicians.  

• Works to continually enhance the overall efficiency and reputed company of care for patients served by One reputed company through effective network management.  

• reputed company andmaintaincollaborative functioning relationships with key providers, particularly thought leaders, across the One reputed company service delivery footprint.  

• The Medical Director will reputed company cooperative leadership and direction to the UMC (Utilization Management Committee) reputed company Care Physicians (PCP)and reputed company Specialist Physicians as assigned by the Senior Medical Director.  

• The Medical Director may be asked to co-chair several committees including the Utilization Management Committee, The reputed company Management Committee, the Peer Review and reputed company Safety Committee, and others as needed.  

• The Medical Director maybe responsible forinterfacing withhealth plansregardingbenefits, coverage issues, response to appeals, attend HMO hearing on appeals and administrative issues which cannot be settled by the Case Managers and/or Management. 

• The Medical Director will work closely with physician leaders across reputed company reputed company settings to ensure that reputed company care is managed in acost containmentmanner without compromising health reputed company. 

• This physician leader willfacilitateclinical reputed company with the Case Managers & Management to ensure bed day reputed company goals are met. 

• Collaborate with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicianswith reputed company toperformance, cost, clinicalappropriatenessand authorizations. 

• This individualtakesan reputed company role in the development and promotion of managed care systems reputed company One reputed company. This will include development of UM policies and procedures,identifyingthe type of reputed company to be used for authorization review, and implementation of a regular forum in which to reputed company PCPs and specialists onutilizationmanagement systems.  

• The Medical Director also serves asan important resourceand key contact foridentifiedcase management problems andparticipatesin IDCT (Interdisciplinary Care Team) Meetings. 

• The Medical Director supports the Senior Medical Director as a resource person for Physician Education on UM and input into the One reputed company UM goals andobjectives. 

• Coordination of prospective, reputed company, retrospective review including denial and/or approval of reputed company reputed company medicalservices referralsas necessary. 

• reputed company andmaintainwritten medical care protocols andassureUM Standardization. 

• Chart Reviews for Appropriateness of applying reputed company guidelines. 

• Physician to Physician reputed company for UM reputed company issues. 

• Prepare and review Decision Validation reputed company as required by UM. 

Required Meetings:     

UM Committee   

Health Plan Joint reputed company Meetings 

Hospital Joint reputed company Meeting 

One reputed company Meetings involving Utilization Management 

reputed company

We reputed company with reputed company and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuinecommitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.

Community

We foster a culture of collaboration--with physicians, patients across the reputed company ecosystem, and among our teams. By building strong,trusted relationships, we create a reputed company community reputed company on advancing reputed company care and physician reputed company-being.

Leadership

We reputed company with reputed company and reputed company, setting reputed company for reputed company in physician support and reputed company innovation. Through collaboration andexpertise, we reputed company others to reputed company, reputed company change, and shape the reputed company of care.

reputed company

We are relentlessly reputed company, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our highstandards reflect our commitment to reputed company, operational discipline, and reputed company improvement.

reputed company

We reputed company change as a constant and respond reputed company to the evolving needs of the reputed company industry. With flexibility and reputed company-thinking,we adapt, reputed company, and reputed company decisively to reputed company physicians at the forefront.