Medical Director Risk Adjustment

  • Compensation: $241,000.00 - $290,000.00 per year
  • Required Qualifications:
  • City/State: Northridge, CA

We're partnered with a large HMO headquartered in Los Angeles to find a Full-Time Medical Director to lead a team of 10!

As the leader of the Risk Department, you'll oversee a mixture of project managers and physician trainers, provide documentation education to contracted physicians, and ensure appropriate reimbursement to the healthplan.

You'll be on-site in Northridge as well as traveling to area clinics, shaking hands with the providers and the leadership team!

This HMO has:

  • has over 500,000 members to date
  • strong leadership team (the current director has been in her role over 10 yrs)
  • over 2500 physicians
  • multiple locations from LA to San Diego

As the Medical Director you'll be:

  • heading the Case Management team creating and approving care plans
  • educating PCPs and their staff on HCC and quality metrics
  • the lead expert on HCC coding
  • sharing knowledge on preventing financial risk
  • flexing your skills working through prior auths, formulary exceptions, and concurrent review
  • be the decision-maker on medical necessity

This plan needs someone well-versed in the managed care space, willing to be "boots on the ground", shaking hands in LA, understands HCC coding and is comfortable providing guidance and direction to physicians.

They have it down- do things right and success follows. They understand what it means to create meaningful interaction between physicians so that patient care is the best it can be, and providers are happy in their role.