The role of the Sr. Medical Director over Utilization Management is intended to oversee the operational efficiency of the prior authorization process across the entire organization, as well as provide strategic oversight for improving this process. This Medical Director work collaboratively with Medical Management to achieve the broader organizational goals, as well as meet specific prior authorization targets.

The responsibilities include:

1. Physician leader for complex specialty services review workflow
2. Physician leader of medical review support for claims adjudication
3. Mentor and curator of prior authorization physician training curriculum
4. Strategic contributor to UM PCP, Specialty, and Facility contracting
5. Ensure that appropriate, evidence-based care is authorized in a timely manner across all campuses/regions.
6. Identify barriers to timely approval of justified care
7. Educate providers/provider support staff on proper authorization request submission
8. Oversee adherence to regulatory compliance
9. MD lead representative at audits and Health Plan engagement activities
10. Establish a synergistic working relationship with other Medical Management departments, Network Management, and other areas of the organization that dovetail with UM
11. This position will require some level of on-site engagement at the various corporate offices, but can be based at any of the available sites. The specific need for travel will be determined moving forward.

Requirements:

• Active unrestricted California license - Physician & Surgeon.
• Current Board Certification, Board Eligible with 5 or more years of UM Review
• DEA privilege.
• Doctoral degree from an accredited School of Medicine or approved School of Osteopathic Medicine.
• Completion of an approved internship and residency.
• Specialty training preferred.
• Minimum of five years of prior clinical experience required.
• Minimum two years of managed-care or health-plan experience required.
• Must demonstrate a strong clinical fund of knowledge.
• Must have familiarity with the principles of clinical research and have the ability to interpret and apply clinical guidelines and policies.
• Strong proficiency in MS Office programs (i.e., Word, Excel, Outlook, Access and PowerPoint) and ability to conduct research over the internet.
• Must have excellent communication skills, both verbal and written.
• Must have strong organization skills.
• Ability to work in a multi-tasking, fast-moving environment.
• Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
• Must be self-motivated, self-guided, driven, and have high personal ethics.
• Must have the ability to work with all levels of management and have the ability to develop positive working relationships with medical directors and company department heads.
• Work as a member of the team.

The pay range for this position at commencement of employment is expected to be between $300,000 - $350,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, the employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming, and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full-Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physicians office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Requirements:

• Active unrestricted California license - Physician & Surgeon.
• Current Board Certification, Board Eligible with 5 or more years of UM Review
• DEA privilege.
• Doctoral degree from an accredited School of Medicine or approved School of Osteopathic Medicine.
• Completion of an approved internship and residency.
• Specialty training preferred.
• Minimum of five years of prior clinical experience required.
• Minimum two years of managed-care or health-plan experience required.
• Must demonstrate a strong clinical fund of knowledge.
• Must have familiarity with the principles of clinical research and have the ability to interpret and apply clinical guidelines and policies.
• Strong proficiency in MS Office programs (i.e., Word, Excel, Outlook, Access and PowerPoint) and ability to conduct research over the internet.
• Must have excellent communication skills, both verbal and written.
• Must have strong organization skills.
• Ability to work in a multi-tasking, fast-moving environment.
• Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
• Must be self-motivated, self-guided, driven, and have high personal ethics.
• Must have the ability to work with all levels of management and have the ability to develop positive working relationships with medical directors and company department heads.
• Work as a member of the team.