Top 1593 Medical director, utilization management remote Jobs in Irvine, Ca

Medical Director MAPD
Clever Care Health Plan —Huntington Beach, CA
- $170 - $190 an hour
- Part-time
- Hybrid work
- Background check
- Medicine
- Senior level
10d
Medical Director for BHRT, functional medicine practice, Florida/California licenses (Remote)
Hormona vida LLC —California
- Email
- Remote
- Background check
- Senior level
- Telehealth
Quick Apply
5d
Director, Revenue Operations - Health Insurance Contracts
Easter Seals Southern California, Inc. —Corona, CA
- From $116,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
7d
Director, Revenue Operations - Health Insurance Contracts
Easter Seals Southern California, Inc. —Irvine, CA
- From $116,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Appeals Medical Director - Remote
UnitedHealthcare —Cypress, CA
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- Word processing
- Computer literacy
Associate Director, CAPA Management | Remote
Optum —Irvine, CA
- $112,700 - $193,200 a year
- Full-time
- Remote
- 5 years
- Pass drug screening
- Senior level
Quick Apply
7d
Appeals Medical Director - Emergency Medicine Required - Remote
UnitedHealthcare —Cypress, CA
- $248,500 - $373,000 a year
- Full-time
- Hybrid work
- Medicine
- Word processing
- Computer literacy
Clinical Consultant - Physician Associate - Remote
UnitedHealthcare —Cypress, CA
- $91,700 - $163,700 a year
- Full-time
- Remote
- Microsoft Outlook
- 5 years
- Pass drug screening
6d
Associate Director, Healthcare Economics (Remote)
Optum —Irvine, CA
- $112,700 - $193,200 a year
- Full-time
- Hybrid work
- Pass drug screening
- Office
- 3 years
13d
Utilization Management Director
United Faith Ministries Inc —Orange, CA
- $200,000 - $235,000 a year
- Full-time
- Nursing
- RN License
- 5 years
- 403(b) matching
- Health insurance
Quick Apply
Controller (Director of Business/Accounting/Fiscal Services)
Anaheim Union High School District —Anaheim, CA
- $182,733 - $203,932 a year
- Full-time
- Senior level
- Health insurance
4d
Medical Director Utilization Management Oncology
Starling Oncology —Cerritos, CA
- $275,000 - $325,000 a year
- Call employer
- Remote
- Medicine
- BC/BE
- Analysis skills
7d
Remote Sr. Director, Healthcare Analytics
Alignment Healthcare USA, LLC —Orange, CA
- $172,364 - $258,547 a year
- Online Application
- Remote
- SQL
- Analysis skills
- Math
Quick Apply
5d
Senior Director, Demand Generation (Remote)
Experian —Costa Mesa, CA
- $176,036 - $316,865 a year
- Full-time
- Remote
- Analysis skills
- Team management
- Travel
- Paid holidays
- Disability insurance
Quick Apply
Director, Medical Staff Administration - Fountain Valley / Placentia Linda - FT Days
University of California, Irvine —Irvine, CA
- $123,000 - $237,800 a year
- Full-time
- Background check
- Customer service
- English
- Health insurance
- Retirement plan
3d
Care Manager - LVN
SCAN Health Plan —Lakewood, CA
- $34.47 - $55.14 an hour
- Full-time
- Remote
- Background check
- LVN
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
Hospice Physician / Medical Director Designee Per Diem
NEXT CARE HOSPICE —Fountain Valley, CA
- $1,000 a month
- Part-time
- Hybrid work
- Medicine
- Mid-level
- Hospice & Palliative Medicine
- Work from home
Quick Apply
8d
Director, Supply Chain Management - Supply Chain - FT - Days
University of California, Irvine —Anaheim, CA
- $132,600 - $259,800 a year
- Full-time
- Background check
- Oracle
- 5 years
- Health insurance
- Retirement plan
Executive Director CMIO
Providence —Irvine, CA
- $111.51 - $205.94 an hour
- Full-time
- Hybrid work
- Medicine
- Travel
- Recruiting
- Paid parental leave
- Paid holidays
9h
Area Medical Director
Carbon Health Technologies Inc —Long Beach, CA
- $170,000 - $310,000 a year
- Full-time
- Hybrid work
- Medicine
- 5 years
- BLS Certification
Quick Apply

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Medical Director MAPD

Clever Care Health Plan -
Huntington Beach, CA

Apply Now

Job Details

Part-time
$170 - $190 an hour
10 days ago

Qualifications

Medical License

Full Job Description

This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County.
This position is a part-time, up to twenty-five (25) hours per week.

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? ✨

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The Part-Time Medical Director provides physician review and clinical oversight for MAPD utilization management, care management, appeals and grievances, quality-of-care review, delegated clinical functions, and CMS audit readiness. This role is a good fit for someone who enjoys working closely with a team, talking through real cases and operational questions, and partnering with clinical and operational leaders to make timely, thoughtful, well-documented decisions that support members and providers while staying aligned with CMS and plan requirements.

Core Responsibilities

UM Reviews & Clinical Decision-Making

Review UM cases where physician input is needed, including prior authorizations, secondary reviews, and medical necessity questions.
Make thoughtful, medically appropriate decisions that balance clinical evidence, plan requirements, and the member’s individual needs.
Use CMS rules, plan criteria, and clinical guidelines in a consistent and well-documented way.
Support peer-to-peer discussions and help work through complex or escalated cases.

Care Management & Population Health

Partner with Care Management and Population Health leadership to provide physician guidance on clinical programs, workflows, and member care strategies.
Provide clinical oversight and physician guidance for Health Risk Assessments (HRAs), Individualized Care Plans (ICPs), Interdisciplinary Care Team (ICT) activities, and Transitions of Care (TOC) to ensure clinical appropriateness, regulatory compliance, and high-quality member care.
Participate in discussions regarding complex member cases, barriers to care, and opportunities to improve care coordination and member outcomes.
Collaborate on development of clinical programs focused on chronic disease management, preventive care, quality improvement, and health equity initiatives.

Appeals, Grievances & Quality-of-Care Review

Review clinical appeals and grievances, including member, provider, and pharmacy-related cases.
Participate in quality-of-care reviews, focused case reviews, and case discussions when physician input is needed.
Make sure decisions are timely, clinically sound, and easy to follow in the documentation.

Delegation Oversight

Provide physician oversight of delegated and internal clinical functions, including Utilization Management, Care Management, Pharmacy, Quality, Population Health, and SNP Model of Care activities. Participate in delegation assessments, performance monitoring, corrective action planning, and ongoing oversight.
Participate in pre-delegation reviews, annual audits, CAP follow-up, and routine performance monitoring.
Raise concerns early when there are clinical, compliance, quality, documentation, or member-safety issues.

CMS Audit & Committee Support

Help prepare for and support CMS program audits, validation audits, mock audits, and other regulatory reviews.
Review samples, determinations, documentation, and universes to make sure they are accurate and audit-ready.
Participate in IRR, UM, Credentialing, P&T, QM, and other committees where physician input is needed.
Serve as the physician representative during CMS, NCQA, and regulatory audits, including supporting audit interviews, universes, and corrective action plan development.

Working Across Teams

Work collaboratively with the CMIO, Care Management, Population Health, Utilization Management, Pharmacy, Quality, Compliance, and Operations to align clinical priorities with operational workflows. Serve as an accessible physician partner who provides timely clinical guidance, supports process improvement initiatives, and helps resolve operational barriers while maintaining a member-centered approach.
Flag potential FWA, compliance, quality, or documentation issues that come up through case review or oversight work.

Clinical Leadership

Foster collaborative relationships with clinical and operational leaders to support organizational priorities and continuous improvement.
Provide physician mentorship and consultation to nursing, pharmacy, and interdisciplinary teams.
Champion a culture of quality, compliance, accountability, and member-centered care.

Qualifications

MD or DO with active unrestricted medical license; board certification in Internal Medicine, Family Medicine, or Geriatrics preferred. Geriatrics training or experience with older adult populations is strongly preferred.
5+ years of Medicare Advantage experience preferred, ideally with prior Medical Director or Physician Advisor experience in a health plan, delegated group, IPA, or similar setting.
Experience with UM, appeals, delegation oversight, CMS audits, coverage criteria, medical necessity review, and clinical documentation standards.
Strong clinical judgment, clear written communication, and a collaborative style; enjoys staying connected to the team and helping solve day-to-day clinical and operational issues.

Success Measures

Strong partnership with operational leaders.
Timely physician support for clinical escalations.
Successful CMS audit readiness and delegation oversight.
Improved collaboration across Care Management, UM, Population Health, and Quality.
Support of quality improvement initiatives that improve member outcomes.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

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Refine Your Search

medical director, utilization management remote jobs in irvine, ca

Medical Director MAPD

Medical Director for BHRT, functional medicine practice, Florida/California licenses (Remote)

Director, Revenue Operations - Health Insurance Contracts

Director, Revenue Operations - Health Insurance Contracts

Appeals Medical Director - Remote

Associate Director, CAPA Management | Remote

Appeals Medical Director - Emergency Medicine Required - Remote

Clinical Consultant - Physician Associate - Remote

Associate Director, Healthcare Economics (Remote)

Utilization Management Director

Controller (Director of Business/Accounting/Fiscal Services)

Medical Director Utilization Management Oncology

Remote Sr. Director, Healthcare Analytics

Senior Director, Demand Generation (Remote)

Director, Medical Staff Administration - Fountain Valley / Placentia Linda - FT Days

Care Manager - LVN

Hospice Physician / Medical Director Designee Per Diem

Director, Supply Chain Management - Supply Chain - FT - Days

Executive Director CMIO

Area Medical Director

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