Salary Range: $206,311.00 (Min.) - $278,520.00 (Mid.) - $350,729.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan, serving more than 2 million members.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents.
Job SummaryThe Medical Director, Community Health, acts as key medical leaders in the organization to help with program development and oversight of Community Health. The Medical Director ensures that the programs align with our operational systems and tools while also performing utilization review of cases.
The Medical Director reports to the Senior Medical Director, Community Health. This position works closely with our Community Platform team as well as with other cross-functional teams within L.A. Care (LAC). The Medical Director is responsible for supporting and ensuring that the development and implementation of Community Health protocols, policy and procedures align with regulatory and contractual requirements, internal core systems, workflows and processes. This position entails network development and relationship building with community-based organizations as well as supporting the oversight team when needed.
DutiesProvide and oversee the delivery and quality assurance of prior and retrospective authorization processes for CalAIM Community Supports and related benefits.Participate in the oversight, support and relationship management with our delegated medical groups and plan partners (Anthem Blue Cross, Care 1st and Kaiser).Work closely with the Community Health team and overall leadership and management accountability matrix as it relates to program development and implementation.Apply necessary skills (clinical, operational, strategic, provider engagement) to ensure that the programs are successful for vulnerable eligible members and providers.Perform utilization review of cases and participate in our care management programs periodically.Provide utilization review and call coverage on scheduled weekends and holidays on a rotational basis.Perform utilization reviews and determinations; address grievance and appeals, and State Fair Hearings.Collaborate with hospitals, Federally Qualified Health Centers, primary care practices, and L.A. County Departments of Health Services, Mental Health, Public Health, and community-based organizations.Perform other duties as assigned.Education RequiredDoctor of Medicine (M.D.)
ExperienceRequired:
At least 8 years of clinical medicine experience after medical school.
Demonstrated experience working in a collaborative or matrix relationship.
Experience in maintaining liaison with Federal, State, and local bodies and medical organizations.
Preferred:
Physicians with social service experience in governmental programs, social service organizations, justice-involved, diversion and re-entry programs, and/or other non-health care related organizations.
Experience with working for underserved, safety net populations including those who are homeless, persons with disabilities, seniors, foster children and youths, and those of various ethnic and cultural backgrounds.
Demonstrated history working with community groups and organizations.
Demonstrated experience in developing and implementing and/or evaluating programs, policies and procedures.
SkillsRequired: Demonstrated ability to provide leadership to physicians, nurses, and other health care and non-health care professionals.Demonstrated ability for teamwork and collaborative problem solving.Demonstrated strong analytic ability.Excellent written and verbal communication skills, negotiating skills, consensus building, and teamwork.Demonstrated ability in public relations including effectiveness in working with community groups and organizations.Understanding and knowledge of homelessness, social determinants of health, children with complex medical conditions, justice-involved populations, and the growing age population.Licenses/Certifications RequiredBoard Certified, preferably in a primary or medical specialty - Active, current and unrestricted California license.
Physical RequirementsLight
Additional InformationSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including: Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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