Per Diem Medical Director

Medical Director Of Utilization And Medical Management

At Altais, we're on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.

Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we're building a stronger, more connected healthcare system.

The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with the Altais Clinical Leadership team in ensuring the delivery of high-quality, efficient and comprehensive healthcare services throughout the continuum of care. This role facilitates and provides information and education for Altais to enable better understanding and skill enhancement in the medical, financial, and utilization practice functions of managed care.

This is a Per Diem opportunity covering selected weekdays, weekends and holidays.

You will focus on:

• The Medical Director plays a vital role in both the development and implementation of Utilization Management policy and procedures.
• Works to continually enhance the overall efficiency and quality of care for patients served by One Altais through effective network management.
• Develop and maintain collaborative functioning relationships with key providers, particularly thought leaders, across the One Altais service delivery footprint.
• The Medical Director will provide cooperative leadership and direction to the UMC (Utilization Management Committee) Primary Care Physicians (PCP) and all Specialist Physicians as assigned by the Senior Medical Director.
• The Medical Director may be asked to co-chair several committees including the Utilization Management Committee, The Quality Management Committee, the Peer Review and Patient Safety Committee, and others as needed.
• The Medical Director may be responsible for interfacing with health plans regarding benefits, coverage issues, response to appeals, attend HMO hearing on appeals and administrative issues which cannot be settled by the Case Managers and/or Management.
• The Medical Director will work closely with physician leaders across all healthcare settings to ensure that patient care is managed in a cost containment manner without compromising health outcomes.
• This physician leader will facilitate clinical rounds with the Case Managers & Management to ensure bed day performance goals are met.
• Collaborate with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicians with regard to performance, cost, clinical appropriateness and authorizations.
• This individual takes an active role in the development and promotion of managed care systems within One Altais. This will include development of UM policies and procedures, identifying the type of criteria to be used for authorization review, and implementation of a regular forum in which to educate PCPs and specialists on utilization management systems.
• The Medical Director also serves as an important resource and key contact for identified case management problems and participates in IDCT (Interdisciplinary Care Team) Meetings.
• The Medical Director supports the Senior Medical Director as a resource person for Physician Education on UM and input into the One Altais UM goals and objectives.
• Coordination of prospective, concurrent, retrospective review including denial and/or approval of all outside medical services referrals as necessary.
• Develop and maintain written medical care protocols and assure UM Standardization.
• Chart Reviews for Appropriateness of applying clinical guidelines.
• Physician to Physician liaison for UM related issues.
• Prepare and review Decision Validation Criteria as required by UM.

The Skills, Experience & Education You Bring:

• Doctor of Medicine degree; valid California licensure; Current Board certification, preferably in a broad based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics.
• A minimum of twelve (12) years as a practicing inpatient and outpatient physician in a managed care environment.
• Active and in good standing unrestricted MD licensure in the state of California

Base Salary: $100.00 - $140.00/hr

You Share Our Mission & Values:

Compassion

Community

Leadership

Excellence

Agility

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.