Medical Director, New Century Health Plan

$142,100 - $348,100/Yr

University of California - Los Angeles, CA

Full-time - Senior

Los Angeles, CA

Educational Services

About the position

This position is a key clinical leadership role within New Century Health Plan, focusing on delivering high-quality, cost-effective care for Medicare Advantage members. The role involves overseeing clinical efforts to optimize care delivery and outcomes, ensuring compliance with regulatory requirements, and collaborating with senior leaders to enhance the performance of the Medicare Advantage Plan.

Responsibilities

• Provide clinical leadership and oversight to ensure the highest standards of care and cost-effectiveness.
• Manage utilization and case management activities to drive efficiency and quality.
• Oversee appeals, grievances, and potential quality issues (PQI).
• Develop and implement clinical strategies to improve health outcomes and ensure compliance with regulatory requirements.
• Collaborate with senior leaders to enhance the overall performance of the Medicare Advantage Plan.

Requirements

• MD or DO degree from an accredited medical school.
• Board certification in a primary care specialty (Internal Medicine, Family Medicine, Geriatrics).
• Valid and unrestricted medical license in California.
• 3 or more years of clinical practice experience.
• 2 years or more years of Medicare Advantage management experience.
• Strong knowledge of Medicare regulations and CMS guidelines.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong communication and interpersonal abilities.
• Proven leadership abilities that demonstrate openness to change and a capacity for implementing creative programs that support strategic initiatives.
• Strong analytical, organizational, and project management skills.
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint).

Nice-to-haves

• Advanced degree in healthcare management or related field, highly desired.
• Experience in a health plan or large healthcare organization, preferred.