Medical Director, Clinical Operations (NCHP)

General Information

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Work Location: Los Angeles, CA, USA Onsite or Remote Flexible Hybrid Work Schedule Monday - Friday, 8:00am - 5:00pm PST; additional weekends and holiday coverage prn as business needs arise Posted Date 09/17/2025 Salary Range: $123500 - 302600 Annually Employment Type 2 - Staff: Career Duration Indefinite Job # 28034

Primary Duties and Responsibilities

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Are you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director, Clinical Operations to help shape the future of our plan. 

In this key leadership role, you’ll work closely with the Medical Director, Department of Health Services and play a vital part in scaling Health Services functions. Your work will directly support our Health Services Department in delivering high-quality, appropriate, and patient-centered care.

What you’ll do:

• Provide clinical determinations for UM (prior authorizations, concurrent reviews, appeals, grievances, peer-to-peer).
• Partner with clinical and operational leaders to ensure high-quality, cost-effective care.
• Collaborate with the Pharmacy team on safe, effective medication use; participate in drug review rounds and P&T Committee.
• Contribute to interdisciplinary care team rounds for complex case management.

The UCLA Health salary range for this title code is $123,500-$302,600/annually. Please note that the department's target pay range is $250,000- $300,000/annually.

Note: This position is a flexible-hybrid role that requires one-day a week on-site in Los Angeles, CA. 

Job Qualifications

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We’re seeking a dynamic and strategic individual with:

Required:

• MD or DO degree, required
• Active, unrestricted California State Medical License, required
• Completion of residency in an adult-based primary care specialty (e.g., Internal Medicine, Family Medicine, Geriatrics), required
• Board Certification in an ABMS, ABOS, or AOA-recognized specialty (preferably Internal Medicine or Family Medicine), required
• 5 or more years of direct patient care experience post residency, required
• Minimum of 2 years of experience in Utilization Management
• 2 or more years of experience working managed care 
• Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case management
• Ability to lea