About Altais: At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Utilization Management, Medical Director is a key physician responsible for advancing clinical excellence, quality outcomes, and utilization management across the network. This is an individual contributor role, primarily performing utilization management functions in the areas of: Prior Authorization Inpatient concurrent review for acute hospitalizations, skilled nursing facility admissions, acute rehabilitation facility admissions Readmission Reviews Network adequacy Claim Reviews Appeals Pharmacy Reviews Peer to peer communication You will focus on: Clinical Leadership: Provide clinical oversight and direction to ensure the quality and efficiency of healthcare services. Develop and implement clinical protocols, guidelines, and standards. Monitor and evaluate clinical performance metrics and outcomes. Quality Improvement: Oversee the implementation of evidence-based practices and clinical pathways. Conduct regular reviews of clinical data to identify areas for improvement. Partner with Quality, Care Management, and Population Health teams to improve HEDIS, Stars, preventive care, care gap closure, and utilization performance metrics. Support identification and management of high-risk, high-cost, and high-opportunity patient populations through data-driven interventions. Provider Relations: Collaborate with providers to address clinical issues, improve care coordination, and promote best practices. Peer to peer discussions Utilization Management & Care Coordination Management of utilization management queues and individual member cases in the areas of: Prior Authorization Inpatient concurrent review for acute hospitalizations, skilled nursing facility admissions, acute rehabilitation facility admissions Readmission Reviews Network adequacy Claim Reviews Appeals Pharmacy Reviews Peer to peer communication Collaborate with care management, case management, and network providers to support high-quality, cost-effective patient care across the continuum. Serve as a clinical resource for complex utilization, authorization, and care management cases. Support development, implementation, and ongoing refinement of utilization management policies, procedures, clinical criteria, and authorization guidelines. Analyze utilization trends, referral patterns, inpatient and outpatient utilization data, and opportunities for improved care coordination and resource stewardship. Partner with operational and clinical leaders to achieve utilization, quality, and population health performance goals. Participate in appeals and peer-to-peer discussions with health plans and providers regarding medical necessity and coverage determinations when appropriate. Provide clinical oversight and input related to high-risk patient management, transitions of care, and complex case reviews. Support provider education regarding utilization management principles, evidence-based practice standards, and appropriate resource utilization. Utilization Management Committee Leadership Participate in and/or chair Utilization Management Committee meetings as assigned. Present utilization trends, performance metrics, and improvement opportunities to clinical and operational leadership. Provide clinical leadership in the development of UM strategies that improve outcomes while maintaining responsible stewardship of healthcare resources. Collaborate with Quality, Population Health, and Care Management teams to align utilization management activities with organizational goals. Compliance and Regulation: Ensure compliance with all regulatory requirements and industry standards. Stay updated on changes in healthcare regulations and implement necessary adjustments. Manage audits and accreditation processes. Strategic Planning and Network Growth: Contribute to the development and execution of the IPA's strategic plan. Identify opportunities for growth and expansion of services. Collaborate with executive leadership to align clinical goals with organizational objectives. Participate in network expansion efforts through presentations, outreach to strategic provider prospects The Skills, Experience & Education You Bring MD or DO degree from an accredited medical school Active and unrestricted medical license Minimum of 5 years of clinical experience, with at least 3 years in utilization management Required Certification: Board certification in a medical specialty Strong understanding of quality improvement methodologies and healthcare regulations. Excellent communication, leadership, and interpersonal skills. Ability to analyze complex clinical data and develop actionable insights. Strong knowledge of utilization management, care management, population health, and value-based care principles. Ability to conduct medical necessity reviews and evaluate clinical appropriateness using evidence-based guidelines. Experience managing provider appeals, authorization reviews, and payer interactions. Understanding of HEDIS, Stars, RAF, quality incentive programs, and managed care performance metrics. Demonstrated ability to influence physician behavior through education, collaboration, and data-driven performance improvement. Preferred Qualifications Experience in an IPA, health plan, ACO, delegated medical group, managed care, or value-based care environment. Experience with utilization management, medical necessity review, provider appeals, care management, population health, and quality improvement programs strongly preferred. Prior experience serving as a Medical Director, Associate Medical Director, or Physician Advisor supporting utilization management, care management, population health, or quality programs. Experience working with delegated managed care arrangements, health plan partners, and utilization management committees. The Compensation for this position is $225,000 to $275,000/year In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. Excellent medical, vision, and dental coverage 401k savings plan with a company match Flexible time off and 9 Paid Holidays You Share Our Mission & Values:  Compassion We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity. Community We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being. Leadership We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care. Excellence We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement. Agility We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront. Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience. Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us. External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. If you’re a big thinker, bold innovator, and fiercely motivated to drive change, consider joining our team. We are dedicated to creating exceptional healthcare experiences by building tools that cultivate the health and well-being of physicians, patients, and the clinical community.

Utilization Management, Medical Director.

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