Medical Director

Location: California

Medical Director page is loaded## Medical Director remote type:
Remote - Full Time locations:
US-California-Remote:
Connecticut, USA:
California, USA:
District of Columbia, USA:
Montana, USAtime type:
Full time posted on:
Posted 5 Days Agojob requisition :
M101457
** Job Description Summary
** The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards.
** How will you make an impact & Requirements
**** This is a remote position; however, candidates located in CA, NV, or AZ are preferred.  
** Care More Health is a physician-founded and physician-led organization that has been transforming care delivery since 1992. With 25 clinics, 65,000+ members and partnerships with 30+ health plans, we’ve built a reputation for delivering exceptional, integrated healthcare experiences to Medicare, Medicaid, and group or private plan members.

Our mission is simple: to improve health outcomes by delivering a transformative and integrated healthcare experience impacting physical, social and emotional well-being. Cultivating life-long relationships with patients, grounded in compassion and unwavering dedication to excellence in care, we’ve built care teams around our patients’ needs — including doctors, nurse practitioners, case managers, community health workers, social workers, pharmacists and specialists, all working together to produce the best outcomes possible.

This people-first, value-based model ensures physicians can practice medicine the way it was meant to be practiced — with time to connect, collaborate, and truly care for patients.
** Key Responsibilities
*** Lead the development, implementation, and periodic review of UM policies and clinical criteria
* Provide physician oversight for concurrent and retrospective review activities
* Approve and interpret clinical guidelines, pathways, and criteria for admission, continued stay, and discharge
* Serve as the primary clinical liaison with payers, providers, and regulatory bodies
* Mentor and educate UM nurses, physician reviewers, and other staff on best practices
* Analyze utilization data and quality metrics to identify trends and areas for improvement
* Participate in appeals and peer-to-peer discussions to resolve clinical disputes
* Maintain compliance with NCQA, URAC, CMS, state regulations, and organizational standards
* Participation in the physician call rotation, requiring coverage for one full weekend (Saturday and Sunday) approximately every four to five weeks. As compensation, one half-day of flex time (AM or PM) is provided during the following work week
** Qualifications
* ** Medical degree (MD or DO) from an accredited institution
* Active, unrestricted medical license in [State/Region]
* Board certification in an acute-care specialty (e.g., Internal Medicine, Family Medicine, Pediatrics)
* Minimum of 5 years clinical practice experience, with 2+ years in utilization management or managed care
** Location
* ** Preference for candidates in CA, NV, or AZ
* Requires availability to work standard Pacific Time Zone business hours, regardless of physical location
** The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.  
**** Compensation:**$0.00to$At Care More Health, we provide effective Advanced Primary Care and Palliative Care by seeing the whole person — body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy-living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted.

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