Medical Director, Community Health

Salary Range:  $206,311.00 (Min.) - $278,520.00 (Mid.) - $350,729.00 (Max.)

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
 

Job Summary

The Medical Director, Community Health, acts as key medical leaders in the organization to help with the program development and oversight of Community Health.  The Medical Director ensures that the programs align with our operational systems and tools while also performing utilization review of cases.

 

The Medical Director reports to the Senior Medical Director, Community Health. This position works closely with our Community Platform team as well as with the other cross-functional teams within L.A. Care (LAC). The Medical Director is responsible for supporting and ensuring that the development and implementation of Community Health protocols, policy and procedures align with regulatory and contractual requirements, internal core systems, workflows and processes. This position entails network development and relationship building with the community based organizations as well as supporting the oversight team when needed.  The Medical Director collaborates, educates our delegated medical groups and plan partners (Anthem Blue Cross and Blue Shield/Promise), and ultimately helps to cascade the CalAIM referral process and eligibility criterial information down to our various provider networks.

Duties

Provide and oversee the delivery and quality assurance of prior and retrospective authorization processes for CalAIM Community Supports and related benefits,

 

Participate in the oversight, support and relationship management with our delegated medical groups and plan partners (Anthem Blue Cross, Care 1st and Kaiser).

 

Work closely with the Community Health team and the overall leadership and management accountability matrix as it relates to the program development and implementation. Share responsibility for the oversight and evaluation of the program. 

 

Apply the necessary skills (clinical, operational, strategic, provider engagement) to ensure that the programs are successful for vulnerable eligible members and providers, and help ensure that the program and its participants meet the regulatory and contractual requirements as intended by CMS and California Department of Health Care Services (DHCS). 

                                                                                                                                         

Perform utilization review of cases and participates in our care management programs periodically.

 

Provide utilization review and call coverage on scheduled weekends and holidays on a rotational basis. 

 

Perform utilization reviews and determinations; and address grievance and appeals, and State Fair Hearings and periodically attend the inter-disciplinary case conferences with our Care Management teams. 

 

Collaborate with hospitals, Federally Qualified Health Centers, primary care practices, and the L.A. County Departments of Health Services, Mental Health, Public Health and community-based organizations and other key partners. Conducts virtual and on-site visits with our community partners when needed.

 

Perform other duties as assigned.

 

Duties Continued

Education Required

Doctor of Medicine (M.D.)

Education Preferred

Experience

Required:
At least 8 years of clinical medicine experience after medical school.

Demonstrated experience working in a collaborative or matrix relationship

Experience in maintaining liaison with Federal, State, and local bodies and medical organizations.

Preferred:

Physicians with social service experience in governmental programs, social service organizations (e.g. homeless or supportive housing), justice-involved, diversion and re-entry programs and/or other non-health care related organizations.  

Experience with working for underserved, safety