Care1st Health Plan is a full service managed care organization offering Medi-Cal, Dental, Medicare and Commercial plans. We are committed to providing health care that is medically excellent, ethically driven and delivered in a patient-centered environment that recognizes the positive relationship between health education, a culture of wellness, an emphasis on prevention and a cost-effective delivery of care.
We are looking for motivated individuals to join our team, who are full of new ideas and a willingness to put those ideas into action.
We currently have a MEDICAL DIRECTOR opportunity in our Monterey Park, CA office location.
Responsible for ensuring that the highest quality of clinical practice, judgment and medical integrity are upheld, implemented and enforced. Provides medical oversight and physician liaison in the areas of Utilization Review, Credentialing, Quality Improvement, Peer Review, Case Management, and Disease Management. Works under the direction of the Chief Medical Officer to ensure the delivery of high quality and efficient care to all members. Provides administrative management of patient care to achieve optimal medical performance in an efficient manner. Ensures that all prior authorization decisions are based on sound medical principles, consistent with approved guidelines and compliant with NCQA, LA Care, MRMIB, DHCS and CMS requirements. Assists in preparing the Plan for all State, Federal and LA Care medical audits.
