You can make a difference in people's lives every day. When you join UCLA Health, you'll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of them plays a vital role in our commitment to care.
Job Duties Responsibilities
Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional health care. Take your career to the next level. You can do all this and more at UCLA Health.
In this key position, you will oversee, coordinate and provide timely ambulatory and inpatient authorization/referral review for the UCLA Medical Group's capitation programs. This includes ambulatory and inpatient management at Ronald Reagan UCLA Medical Center, Santa Monica UCLA Medical Center and Orthopedic Hospital, and community hospitals You will be responsible for Medical Director level inpatient facility management, outpatient utilization management/review and external relationships with health plans and other initiatives as directed.
For UCLA Medical Group capitation programs you will:
Oversee, coordinate, and provide ambulatory referral/authorization determinations
Manage, coordinate, and supervise inpatient and post-acute care management with case managers
Manage patients in non-UCLA acute hospitals and skilled nursing facilities (SNF)
Supervise inpatient, outpatient, ambulatory and SNF case managers
Provide direct communication with UCLA and non-UCLA physicians for optimal care management
Supervises utilization management of inpatient, outpatient and ambulatory authorizations
Collaborate with UCLA Medical Group analysts to develop utilization management reports
Facilitate the management of complex patients
Collaborate with UCLA Medical Group, FPG Leadership and OPHAC to optimize RAF scores, improve quality and lower Total Cost of Care
UCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.
Job Qualifications Qualifications
We're seeking an exceptionally gifted leader with:
- MD or DO with a current unrestricted California medical license
- Board certification in an American Board of Medical Specialties or Bureau of Osteopathic Specialists recognized specialty
- At least three years of clinical experience providing direct patient care
- Extensive experience in ambulatory utilization management and case management supervision
- Proven expertise in managed care/capitation management-related environments
- Knowledge of nationally recognized criteria (e.g., Milliman, Interqual etc.), medical necessity and benefit interpretation for both ambulatory and inpatient careUnderstanding of general health plan and regulatory requirements for utilization management, denials and appeals in a Medical Group capitation environment