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Medical Director Utilization Management Jobs in Riverside, CA

KPC Global MSO

Utilization Review LVN

Santa Ana, CA · On-site

Identification of referrals to the medical director for review * Appropriate letter language and ... Minimum two (2) years managed care experience in UM/CM Department, preferred SKILLS & ABILITIES ...

Medix

SNF Review Nurse (LVN or RN)

Orange, CA · On-site

$38 - $51/hr

... and Medical Directors. Responsibilities * Manage the full Utilization Management process from initial review through discharge planning. * Conduct daily inpatient and concurrent reviews and ...

HealthCare Support

Utilization Management

Orange, CA · On-site

$37.43 - $50/hr

LVN Prior Authorization Nurse / Case Manager HealthCare Support is actively seeking a LVN Prior ... Reviews authorization requests for CalAIM services for medical appropriateness utilizing medical ...

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Medical Director Utilization Management information

See Riverside, CA salary details

$13.6K

$242.4K

$372.4K

How much do medical director utilization management jobs pay per year?

As of Sep 8, 2026, the average yearly pay for medical director utilization management in Riverside, CA is $242,423.00, according to ZipRecruiter salary data. Most workers in this role earn between $206,600.00 and $296,800.00 per year, depending on experience, location, and employer.

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What are the key skills and qualifications needed to thrive as a medical director utilization management?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Riverside, CA?

For Medical Director Utilization Management jobs in Riverside, CA, the most frequently searched job titles are:

What job categories do people searching Medical Director Utilization Management jobs in Riverside, CA look for?

The top searched job categories for Medical Director Utilization Management jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Medical Director Utilization Management jobs?

Cities near Riverside, CA with the most Medical Director Utilization Management job openings:

Medical Director Utilization Management jobs near you

Inpatient Medical Director (SoCal)

Astrana Health Management

Orange, CA • On-site

$250/hr

Other

Re-posted 28 days ago

Job description

Inpatient Medical Director (SoCal)

Department: HS - Providers

Employment Type: Full Time

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Reporting To: Dr. Derek Lanier

About the Role

The Inpatient Medical Director provides physician leadership across Astrana Health’s hospital partners, ensuring high‑quality, cost‑effective inpatient care aligned with Astrana’s value‑based and population health strategies. This leader partners closely with hospitalists, specialists, care management, and health plan counterparts to drive clinical excellence, utilization management, and continuity of care across the inpatient–post‑acute continuum.

What You'll Do
  • Serve as physician leader for inpatient clinical operations across assigned hospitals.
  • Drive quality, safety, and patient outcomes aligned with Astrana Health’s value‑based and capitated risk programs.
  • Partner with hospitalists, specialists, nursing leadership, and case management to optimize LOS, avoidable utilization, and transitions of care.
  • Oversee physician performance, clinical compliance, and adherence to evidence‑based protocols and pathways.
  • Collaborate with Population Health, Utilization Management, and Post‑Acute teams to reduce readmissions and total cost of care.
  • Support payer and delegated risk requirements, including clinical documentation, medical necessity, and audits.
  • Act as clinical liaison between Astrana Health, hospital partners, and community physicians.
What Success Looks Like
  • Improved inpatient quality and safety metrics.
  • Reduced LOS, readmissions, and unnecessary utilization.
  • Strong physician engagement and alignment with Astrana Health’s clinical and financial goals.
  • Seamless care transitions across the continuum.
Qualifications
  • Medical Degree (MD or DO) from an accredited institution; active and unrestricted medical license in CA.
  • 5+ years of inpatient clinical experience; prior physician leadership.
  • Experience in value‑based care, risk‑bearing models, or delegated health plan environments.
  • Strong working knowledge of utilization management, quality metrics, and hospital operations.
  • Proven ability to lead, influence, and collaborate across multidisciplinary teams.
  • 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.
Environmental Job Requirements and Working Conditions
  • While this is a Remote - US Based position, this MD will need to reside SoCal to travel to inpatient, post-acute facilities, physician groups, ASC, and Health Plans.
  • The national target pay range for this role is $250,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job‑related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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