Utilization Management, Medical Director

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 Utilization Management, Medical Director is a key physician responsible for advancing clinical excellence, quality outcomes, utilization management, and provider engagement across the network. This role provides clinical oversight, supports evidence-based care delivery, and partners with providers, care management teams, and operational leaders to improve healthcare quality, patient outcomes, and effective stewardship of healthcare resources. The Medical Director helps ensure compliance with regulatory requirements, supports utilization and population health initiatives, and contributes to strategic growth through provider recruitment, retention, and network development. With a focus on aligning clinical, operational, and organizational priorities, this role serves as a trusted physician leader in advancing value-based care and high-performing provider networks.
You will focus on:
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Clinical Leadership:

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Provide clinical oversight and direction to ensure the quality and efficiency of healthcare services.

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Develop and implement clinical protocols, guidelines, and standards.

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Monitor and evaluate clinical performance metrics and outcomes.

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Quality Improvement:

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Lead quality improvement initiatives to enhance patient care and safety.

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Oversee the implementation of evidence-based practices and clinical pathways.

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Conduct regular reviews of clinical data to identify areas for improvement.

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Partner with Quality, Care Management, and Population Health teams to improve HEDIS, Stars, preventive care, care gap closure, and utilization performance metrics.

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Support identification and management of high-risk, high-cost, and high-opportunity patient populations through data-driven interventions.

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Provider Relations:

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Foster strong relationships with network physicians and healthcare providers.

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Collaborate with providers to address clinical issues, improve care coordination, and promote best practices.

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Facilitate educational sessions and training programs for providers.

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Utilization Management & Care Coordination

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Provide physician leadership for utilization management activities, ensuring appropriate, effective, and evidence-based use of healthcare resources.

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Collaborate with care management, case management, and network providers to support high-quality, cost-effective patient care across the continuum.

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Participate in prospective, concurrent, and retrospective utilization review activities, including review of medical necessity determinations, treatment plans, hospital admissions, and specialty referrals.

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Serve as a clinical resource for complex utilization, authorization, and care management cases.

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Support development, implementation, and ongoing refinement of utilization management policies, procedures, clinical criteria, and authorization guidelines.

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Analyze utilization trends, referral patterns, inpatient and outpatient utilization data, and opportunities for improved care coordination and resource stewardship.

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Partner with