California Licensed Medical Director

Job Summary

Seeking a California Licensed Medical Director for Utilization Management, this full-time or part-time position will provide clinical oversight and strategic leadership in utilization review operations, ensuring high-quality, cost-effective care while working remotely with some travel to Southern California as needed.

Key responsibilities

• Manage prior authorization processes, ensuring compliance with medical necessity and evidence-based guidelines
• Oversee daily activities of the utilization management program, analyzing data to optimize care and reduce costs
• Lead quality assurance initiatives to meet regulatory standards and improve prior authorization and UM processes

Required qualifications

• Medical Degree (MD or DO) with an active, unrestricted California medical license
• Board certification in a relevant specialty preferred
• At least 5 years of clinical practice experience and 3 years in utilization management or medical management
• In-depth knowledge of managed care, value-based care, and relevant regulatory guidelines
• Proficiency in applying MCG, InterQual, or equivalent criteria