Medical Director

Medical Director, Utilization ManagementMedical Director, Utilization Management (MD/DO) – Part Time Pay: $139.23 – $189.38 per hour — roughly $145,000–$197,000 a year for a 20-hour week Schedule: Part-time, 20 hours per week Location: San Diego, CA License: Active, unrestricted California MD or DO + DEA + BLS MASC Medical is recruiting a part-time Medical Director of Utilization Management for a San Diego PACE program (Program of All-Inclusive Care for the Elderly) serving frail, dual-eligible older adults. This is a 20-hour-a-week physician leadership role with no patient panel and no call. You'd own medical necessity determinations across outpatient, inpatient, and post-acute settings, run peer-to-peer conversations, and lead the appeals process — the clinical judgment part of the job, without the RVU treadmill. It's built for an internist or geriatrician who has done the clinical years and wants to influence how care gets delivered for a whole population instead of one patient at a time.What you'll doMake and direct medical necessity determinations for outpatient, inpatient, and post-acute care (SNF, ALF, LTACH, palliative, hospice, home health)Apply InterQual and CMS coverage criteria; own the standards and train the team on how to use themLead peer-to-peer discussions with site medical directors, PCPs, and external network and non-contracted providersServe as physician reviewer on escalated and complex utilization casesLead and protect the integrity of the appeals and grievance process under CMS, Medi-Cal, and PACE requirementsSupport authorization review, concurrent review, and denial management alongside nurse UM specialistsMonitor for over- and under-utilization; spot patterns driving avoidable admissions and length-of-stayProvide oversight of HCC/ICD-10 diagnosis coding and RAF accuracyDevelop medical policy and drive evidence-based clinical guideline adoptionPartner with the CMO, Behavioral Health Director, Health Plan Director, and interdisciplinary teamsChair or sit on committees including credentialing and P&TDocument to PACE, NCQA, and CMS standards and support audit readinessWhat you'll needMust have Active, unrestricted California MD or DO licenseActive DEA registrationCurrent BLSBoard certified or board eligible in a primary care specialty5+ years of clinical practice in Internal Medicine, Geriatrics, and/or Family Medicine3+ years in utilization/resource management or medical leadership within managed care, a health plan, or a value-based care settingWorking command of Medicare and Medicaid/Medi-Cal regulations and CMS coverage criteriaExperience applying evidence-based UM guidelines (InterQual preferred; MCG acceptable)Nice to have PACE clinical or PACE utilization management experienceAdvanced degree — MPH, MHA, MBA, or MSACLSEpic and QuickCap familiarityBilingual Spanish–EnglishWhy physicians take this role$139–$189/hour — top of market for part-time physician UM work in Southern California20 hours a week. Genuinely part-time, not a full-time job priced hourlyNo patient panel, no call, no productivity targetsReal authority: you set the criteria, chair the committees, and own the appeals processPopulation-level impact on a frail, dual-eligible senior population where good UM decisions visibly change outcomesWorks alongside continued clinical practice, a teaching role, or a phased wind-down