[Hiring] Medical Director @Altais

Role Description

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 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.

You will focus on:

• The development and implementation of Utilization Management policy and procedures.
• Enhancing the overall efficiency and quality of care for patients served by One Altais through effective network management.
• Developing and maintaining collaborative functioning relationships with key providers, particularly thought leaders, across the One Altais service delivery footprint.
• Providing 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.
• Co-chairing several committees including the Utilization Management Committee, The Quality Management Committee, the Peer Review and Patient Safety Committee, and others as needed.
• Interfacing with health plans regarding benefits, coverage issues, response to appeals, and attending HMO hearings on appeals and administrative issues which cannot be settled by the Case Managers and/or Management.
• Working closely with physician leaders across all healthcare settings to ensure that patient care is managed in a cost containment manner without compromising health outcomes.
• Facilitating clinical rounds with the Case Managers & Management to ensure bed day performance goals are met.
• Collaborating with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicians regarding performance, cost, clinical appropriateness, and authorizations.
• Taking an active role in the development and promotion of managed care systems within One Altais.
• Serving as an important resource and key contact for identified case management problems and participating in IDCT (Interdisciplinary Care Team) Meetings.
• Supporting the Senior Medical Director as a resource person for Physician Education on UM and input into the One Altais UM goals and objectives.
• Coordinating prospective, concurrent, retrospective review including denial and/or approval of all outside medical services referrals as necessary.
• Developing and maintaining written medical care protocols and assuring UM Standardization.
• Conducting chart reviews for appropriateness of applying clinical guidelines.
• Acting as a Physician to Physician liaison for UM related issues.
• Preparing and reviewing Decision Validation Criteria as required by UM.

Required Meetings:

• UM Committee
• Health Plan Joint Operations Meetings
• Hospital Joint Operations Meeting
• One Altais Meetings involving Utilization Management

Qualifications

• 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.

Requirements

• The Compensation for this position is $222,750 - $267,300/year.
• In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

Benefits

• Excellent medical, vision, and dental coverage.
• 401k savings plan with a company match.
• Flexible time off and 9 Paid Holidays.

Company Description

Altais is 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.