Medical Director, Utilization Management

LA Care Health Plan

Los Angeles, CA, US
Base: $206,311.00 - $350,729.00; bonus/equity: not...
On-site
Clinical oversight of utilization management
Payment integrity clinical validation
Fraud waste and abuse mitigation
L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality health care for vulnerable and low-income communities in Los Angeles County

Job Summary

  • L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality health care for vulnerable and low-income communities in Los Angeles County.
  • The Medical Director leads clinical oversight for utilization management and payment integrity, ensuring evidence-based, timely, and defensible clinical decisions while mitigating Fraud, Waste, and Abuse risks.
  • The organization offers a wide range of benefits including Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical, Dental and Vision coverage, Wellness Programs, and Volunteer Time Off.

Matching Summary

L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality health care for vulnerable and low-income communities in Los Angeles County.

Salary

Base: $206,311.00 - $350,729.00; Bonus/Equity: Not specified; Benefits: Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical, Dental, Vision, Wellness Program, Volunteer Time Off

Skills & Requirements

Must-have

  • clinical oversight of utilization management
  • payment integrity clinical validation
  • Fraud Waste and Abuse mitigation
  • collaboration with multidisciplinary teams
  • evidence-based medical policy development
  • regulatory compliance and quality assurance

Nice-to-have

  • leadership in physician teams
  • experience with Medicaid managed care
  • commitment to health equity
  • strategic and business-oriented thinking
  • strong presentation and communication skills

Key Requirements

  • Doctor of Medicine (M.D.)
  • Board Certified in Internal Medicine, Family Medicine, Emergency Medicine or Psychiatry
  • Active, current and unrestricted California medical license
  • At least 8 years medical management experience
  • Experience in Payment Integrity and managed care
  • Physician leadership and team management experience

Work Rights

Active, unrestricted California medical license required

Tailored Resume

Cover Letter