Utilization Management Medical Director - Full Time, CA License (Remote)

  • Prospect Medical Systems
  • Remote
  • Jul 06, 2022
Physician

Job Description

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Medical Director of Utilization Management provides medical leadership and has responsibility for the PMS Utilization Management Department. Responsibilities include facilitation of evidence-based and cost-effective professional and institutional services to our membership through oversight of the day-to-day operations. Mentoring and assisting in the training of clinical and non-clinical leaders to ensure compliance with legal requirements. Chairs and/or participates in various committees to support performance improvement, improve utilization and quality of medical care, and the physician and patient experience - including, but not limited to oversight of peer review and risk management. Engages physicians to promote relationships and alignment with organizational goals.

Job Responsibilities/Duties

  • Provides physician oversight of the Utilization Management and Prior Authorization process to ensure the delivery of cost-effective, high quality, and appropriate medical care as needed
  • Adherence to Prospect’s denial process and compliance with industry standards and denial ratios
  • Works closely with UM team members in meeting timely turnaround on referrals
  • Collaborates with team members in the development, implementation, management, monitoring, and evaluation of the effectiveness of UM processes
  • Physician education and manages relationships with health plans
  • Works proactively and collaboratively across the organization to ensure overall business objectives are met and supported.
  • Attends various meetings and participates on committees as appropriate contributing ideas for improving efficiency, productivity, and member satisfaction
  • Other job duties as assigned

Qualifications

Minimum Education: None. 

Minimum Experience: Five (5) years of clinical care experience. Minimum of three (3) years of utilization management.  Strong clinical acumens. Some experience in medical leadership or oversight responsibilities, required.

Req. Certification/Licensure: Licensed Medical Doctor in the State of California, preferred.  Board-certification, preferred.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/

Position Summary

Employment Status: Regular Full-time

Shift: Days

Work Schedule: Monday - Friday

Address: California - Remote