Assistant Medical Director

Assistant Medical Director

Western Health Advantage (WHA) is seeking an experienced Assistant Medical Director to support high-quality, cost-effective care for our members through clinical leadership in Utilization Management, Quality Improvement, Population Health, Delegated Oversight, and Regulatory Compliance. This role partners across departments, provider organizations, and vendors to improve member outcomes and support strategic clinical initiatives.

Key Responsibilities

• Review complex medical cases and medical necessity determinations using evidence-based criteria (InterQual, MCG, CMS).
• Conduct peer-to-peer reviews and provide clinical consultation on utilization management decisions.
• Support delegated medical group oversight, audits, regulatory readiness, and performance improvement initiatives.
• Collaborate with Quality and Population Health teams to improve HEDIS measures, care gap closure, health equity, and member outcomes.
• Participate in NCQA, DMHC, and CMS compliance activities.
• Provide clinical guidance on benefit interpretation, policy development, and emerging healthcare technologies.
• Support vendor oversight and evaluation for utilization management, behavioral health, and population health programs.
• Serve as a clinical resource for internal departments, providers, and external partners.
• Participate in key organizational committees and support special projects assigned by the Chief Medical Officer.

Qualifications

• MD or DO with an active, unrestricted California medical license.
• Current Board Certification (ABMS or AOA).
• Minimum 5 years of clinical experience in primary care or hospital medicine.
• Minimum 3 years of experience working with capitated HMO populations.
• Minimum 2 years of medical administrative or managed care experience.
• Knowledge of NCQA, DMHC, CMS, Utilization Management, and Quality Improvement programs.
• Strong communication, analytical, and relationship-management skills.

Why Join WHA?

Join a mission-driven organization dedicated to improving healthcare quality, advancing health equity, and delivering exceptional value to members throughout Northern California.

Equal Employment Opportunity

Western Health Advantage is committed to providing equal employment opportunities to employees and applicants based on merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis protected by federal or state law.

Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization. Collaborating with top talent creates a dynamic and fulfilling work environment while enabling exceptional service for our members.

Western Health Advantage