Senior Clinical Strategist

Há 3 dias

Nova Iguaçu, Rio de Janeiro, Brasil beBeeCareer Tempo inteiro US$250.000 - US$300.000
Medical Leadership Opportunity

We are seeking a skilled Medical Director to provide clinical oversight and strategic leadership in our utilization review operations. As a key member of our team, you will ensure that members receive high-quality, medically appropriate, and cost-effective care.

This role requires a clinically grounded physician who thrives in a data-informed, team-based environment and is passionate about transforming how care is delivered in a risk-bearing, population health-focused ecosystem.

Key Responsibilities:
  • Provide clinical oversight for the daily activities of the UM program, ensuring services are delivered appropriately and in accordance with clinical best practices.
  • Analyze utilization data to identify trends, high-cost drivers, and opportunities for care optimization and cost containment.
  • Participate in the clinical review of complex or high-cost cases, offering recommendations rooted in medical necessity and member-centered care.
  • Collaborate with interdisciplinary clinical teams to ensure the appropriate use of healthcare resources without compromising quality.
Requirements:
  • Medical Degree (MD or DO) from an accredited institution; active and unrestricted medical license in CA.
  • Board certification (preferred) in a relevant specialty (e.g., Internal Medicine, Family Medicine, or equivalent).
  • Minimum 5+ years of clinical practice experience.
  • At least 3 years of experience in utilization management or medical management within a health plan, IPA/MSO, or risk-bearing organization.
  • Deep knowledge of managed care, value-based care, capitation, and CMS/Medi-Cal guidelines.
  • Proficient in applying MCG, InterQual, or equivalent criteria.
  • Strong understanding of state and federal regulations (e.g., CMS, DMHC, NCQA).
  • Excellent communication skills, including the ability to engage providers in meaningful, respectful clinical dialogue.
  • Highly collaborative mindset with a commitment to improving healthcare equity, quality, and cost-effectiveness.

Astrana Health offers a dynamic work environment with opportunities for growth and development. We are proud to be an Equal Employment Opportunity and Affirmative Action employer.

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