Medical Director, Utilization Management

Company: UCLA HEALTH
Location: Los Angeles
Posted on: July 1, 2020

Job Description:

ResponsibilitiesTake on ahigh-impact role within a world-class health organization. Help drive thecontinued delivery of exceptional health care. Take your career to the nextlevel. You can do all this and more at UCLA Health.In this keyposition, you will oversee, coordinate and provide timely ambulatory andinpatient authorization/referral review for the UCLA Medical Group's capitationprograms.-- This includes ambulatory andinpatient management at Ronald Reagan UCLA Medical Center, Santa Monica UCLAMedical Center and Orthopedic Hospital, and community hospitals You will beresponsible for Medical Director level inpatient facility management, outpatientutilization management/review and external relationships with health plans andother initiatives as directed.For UCLAMedical Group capitation programs you will: Oversee, coordinate, and provide ambulatory referral/authorizationdeterminations Manage, coordinate, and supervise inpatient and post-acute care management withcase managers Manage patients in non-UCLA acute hospitals and skilled nursing facilities(SNF) Supervise inpatient, outpatient, ambulatory and SNF case managers Provide direct communication with UCLA and non-UCLA physicians for optimal caremanagement Supervises utilization management of inpatient, outpatient and ambulatoryauthorizations Collaborate with UCLA Medical Group analysts to develop utilization managementreports Facilitate the management of complex patients Collaborate with UCLA Medical Group, FPG Leadership and OPHAC to optimize RAFscores, improve quality and lower Total Cost of CareQualificationsWe're seeking an exceptionally gifted leader with:MD or DO with a current unrestricted California medical licenseBoard certification in an American Board of Medical Specialties or Bureau ofOsteopathic Specialists recognized specialtyAt least three years of clinical experience providing direct patient careExtensive experience in ambulatory utilization management and case management supervisionProven expertise in managed care/capitation management-related environmentsKnowledge of nationally recognized criteria (e.g., Milliman, Interqual etc.),medical necessity and benefit interpretation for both ambulatory and inpatientcareUnderstanding of general health plan and regulatory requirements forutilization management, denials and appeals in a Medical Group capitationenvironmentUCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

Keywords: UCLA HEALTH, Los Angeles , Medical Director, Utilization Management, Executive , Los Angeles, California