UM Medical Director - Casual
About Altais:
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.
About the Role
Are you looking to join a fast-growing, dynamic team?
We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.
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 andInnovation, andwork closely with the Altais Clinical Leadership teamin ensuring the delivery of high-quality, efficient and comprehensive healthcare services throughout the continuum of care. This rolefacilitatesand provides information and education for Altais to enable better understanding and skill enhancement in the medical, financial, andutilizationpractice functions of managed care.
This role is a Casual, 1-month long opportunity. You must be able to work operating business hours on Pacific Standard Time.
You will focus on
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The Medical Director plays a vital role in both the development and implementation of Utilization Management policy and procedures. This physician is chosen based upon their knowledge of medical practice, experience in Managed Care,Utilization, Quality Managementprogramsand an ability to interact well with the other physicians.
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Works to continually enhance the overall efficiency and quality of care for patients served by One Altais through effective network management.
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Develop andmaintaincollaborative functioning relationships with key providers, particularly thought leaders, across the One Altais service delivery footprint.
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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.
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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.
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The Medical Director maybe responsible forinterfacing withhealth plansregardingbenefits, coverage issues, response to appeals, attend HMO hearing on appeals and administrative issues which cannot be settled by the Case Managers and/or Management.
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The Medical Director will work closely with physician leaders across all healthcare settings to ensure that patient care is managed in acost containmentmanner without compromising health outcomes.
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This physician leader willfacilitateclinical rounds with the Case Managers & Management to ensure bed day performance goals are met.
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Collaborate with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicianswith regard toperformance, cost, clinicalappropriatenessand authorizations.
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This individualtakesan active role in the development and promotion of managed care systems within One Altais. This will include development of UM policies and procedures,identifyingthe type of criteria to be used for authorization review, and implementation of a regular forum in which to educate PCPs and specialists onutilizationmanagement systems.
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The Medical Director also serves asan important resourceand key contact foridentifiedcas