Medical Director - SoTalent : Job Details

Position: Senior Medical Director – Health Plan Oversight

Location: Hybrid | Based in California

Compensation: Hourly Rate Range – $111.99 to $177.01

About the Role

An established healthcare organization is seeking a strategic physician leader to guide clinical performance and utilization oversight for its health plan operations. In this influential role, you'll work closely with executive leadership to ensure high-quality, cost-effective care delivery across a broad range of services. This role serves as both a policy advisor and operational lead for clinical programs within a managed care environment.

As a key member of the leadership team, you'll shape the organization's medical strategy, ensure regulatory compliance, and play a pivotal role in maintaining performance standards aligned with national accreditation and quality benchmarks.

Core Responsibilities

• Provide strategic oversight of medical programs, collaborating with executives to shape healthcare delivery and cost management strategies.
• Implement, monitor, and refine utilization review and clinical quality improvement initiatives across inpatient, outpatient, preventive, and specialty services.
• Lead cross-functional collaboration with teams across member services, provider relations, benefits, claims, and quality departments.
• Guide physician reviewers, support credentialing and appeals processes, and respond to complex clinical grievances.
• Ensure alignment with regulatory frameworks such as NCQA and state health plan requirements, including documentation and audits.
• Analyze clinical performance data, support development of strategic planning efforts, and recommend policy or process changes as needed.
• Facilitate provider engagement through performance feedback, education, and incentive program development.
• Serve as a liaison for physician groups, vendors, and community stakeholders to promote collaborative relationships and consistent care standards.
• Maintain 24/7 coverage availability for urgent authorization decisions and clinical inquiries through shared coverage rotation.

What You Bring

• Medical Degree (MD or DO) from an accredited institution
• Valid and unrestricted California medical license
• Board certification (preferably in Internal Medicine or Family Medicine)
• Prior clinical experience with a minimum of several years in medical practice
• Proven background in a managed care setting, with prior leadership experience in medical administration or as a medical director
• Solid understanding of U.S. healthcare regulations, quality initiatives, and utilization review principles
• Familiarity with benefit design, medical necessity determinations, and coverage policies
• Ability to interpret performance metrics, claims data, and healthcare analytics
• Clear communication skills with the ability to educate, influence, and lead cross-functional teams
• Capacity to adapt to fast-paced environments and shifting regulatory demands

Preferred Experience

• Executive-level experience in managed healthcare, ideally within an HMO or PPO framework
• Familiarity with accreditation requirements and quality scoring systems such as HEDIS
• Experience working with diverse populations and an appreciation for culturally competent care
• Exposure to enterprise healthcare platforms or medical review software systems

What's Offered

• Competitive hourly pay within a wide range based on experience and credentials
• Flexible hybrid work model
• Supportive team environment with a focus on professional collaboration and innovation
• Opportunity to directly impact patient outcomes and organizational performance
• Continued professional development within a mission-driven healthcare organization