California Licensed Medical Director

Job Summary

A company is looking for a Medical Director - Utilization.

Key Responsibilities

• Lead clinical review of prior authorizations and hospitalizations to ensure medical necessity
• Collaborate with cross-functional teams to support whole-person care and quality improvement
• Analyze service utilization patterns to inform population health strategies and policy development

Required Qualifications

• Medical Degree (MD or DO) with an active and unrestricted medical license in CA
• Board certification in a relevant specialty
• Minimum 5+ years of clinical practice experience
• At least 3 years of experience in utilization management within a health plan or risk-bearing organization
• Deep knowledge of managed care and relevant state and federal regulations