Medical Director - Inpatient
 SCAN Group | |
paid holidays, tuition reimbursement, 401(k)
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 United States, California, Long Beach | |
 Jul 04, 2025 | |
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Description
This is a remote position with a requirement to be onsite at least once a month. Travel will be necessary to engage with provider partners across multiple states. About SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 300,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter. At SCAN Health Plan, we are dedicated to delivering high-quality, person-centered care across the healthcare continuum. We are seeking a seasoned and visionary Inpatient Medical Director to join our clinical leadership team. This is an exceptional opportunity for a physician leader who is passionate about transforming care delivery, driving innovation, and achieving measurable improvements in patient outcomes. In this pivotal role, you will lead efforts to engage medical groups, hospitalists, emergency department physicians, primary care providers, and specialists to ensure seamless coordination of inpatient care and effective transitions that reduce avoidable readmissions. As Inpatient Medical Director, you will shape and oversee inpatient care strategies across all SCAN markets. You will collaborate closely with SCAN leadership to provide clinical and operational guidance in key areas including Utilization Management, Appeals and Grievances, Medical Claims, and Medical Policy. Your leadership will directly support SCAN's mission to advance the quadruple aim: enhancing patient experience, improving health outcomes, supporting care team well-being, and promoting cost efficiency. This is a remote position with a requirement to be onsite at least once a month. Travel will be necessary to engage with provider partners across multiple states. This corporate role supports SCAN Health Plan's clinical operations across all service areas and serves as the primary point of contact for internal clinical teams on utilization management and quality initiatives. You Will Inpatient Medical Oversight: The Inpatient Medical Director oversees the quality, efficiency, and strategic direction of inpatient care delivered by hospitalists across hospitals, LTACs, and SNFs. This includes designing and implementing inpatient programs across markets to meet quality and utilization goals. Team Leadership and Program Development: Lead a multidisciplinary team of inpatient case managers, transition-of-care coordinators, and discharge planners. Develop and implement policies and workflows that drive performance in quality metrics and ensure compliance with regulatory standards. Utilization Management Support: Provide clinical guidance and interpretation for utilization management operations, including prior authorization, concurrent and retrospective reviews, and claims adjudication. Interdisciplinary Team Participation: Actively participate in interdisciplinary team (IDT) rounds with a focus on quality of care, utilization management, and care transitions. Provider Collaboration: Engage in peer-to-peer discussions with provider partners to address utilization, grievances, and appeals, aiming to improve care quality and resolve system challenges. Medical Policy Consultation: Offer medical expertise to the medical policy team on operational issues, ensuring alignment with Medicare, State and SCAN guidelines. Recommend process improvements to enhance efficiency and effectiveness. Grievance and Appeals Review: Conduct clinical reviews for grievance and appeals and support the escalation of complex cases to the Medical Director level when appropriate. Out-of-Area Member Oversight: Provide medical oversight for out-of-area members to ensure optimal outcomes in quality and efficiency. Clinical Guideline Development: Contribute to the creation of evidence-based case management and clinical guidelines for programs such as disease management and complex care management. Regulatory and Legal Representation: Represent SCAN in Administrative Law Judge (ALJ) appeal cases and during CMS and DHCS audits. Performance Improvement and Committee Leadership: Support the implementation of performance improvement initiatives, particularly those focused on 5-STAR quality metrics. Provide leadership and participate in key clinical committees including P&T, Credentialing, Peer Review, and Utilization Management. Review quality of care cases and make recommendations to relevant committees. Evaluate complex or unusual provider and facility claims for medical necessity and appropriate payment. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of SCAN's Vision and Goals. Other duties as assigned. Your Qualifications Required Certifications or Licenses: Physicians (MDs). Unrestricted California State Medical License required. Licensing in other states will be required to obtain based on business needs. Board Certification in one of ABMS categories required. Board certification in Internal Medicine or Family Practice is strongly preferred. A minimum of five years' experience in active clinical practice in an adult-based primary care specialty (preferably Internal Medicine or Family Practice) is required. Recent hospital experience (within the past five years) is highly desirable. Experience in Health Plan or Medical Group operations. Background in appeals and grievances review, utilization management, case review, and/or quality improvement within a managed care setting is strongly preferred. In-depth knowledge of Medicare policies and guidelines. Demonstrated leadership and management capabilities. Strong interpersonal, written, and verbal communication skills with a keen attention to detail. Proven experience in inpatient care management, utilization review, or medical leadership roles. Ability to thrive in a fast-paced, mission-driven environment. Strategic thinker with exceptional collaboration and communication skills. A dynamic physician leader with sound clinical judgment and a passion for improving healthcare delivery. Technical expertise - Advanced analytical skills Business Insight - In-Depth understanding of the business Problem Solving - Good problem-solving skills Communication - Good communication and interpersonal skills Strong clinical skills especially in creating evidence-based utilization management, disease management and quality improvement programs. What's in it for you? We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now! At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. SCAN 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. #LI-CS2 #LI-Hybrid Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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