Associate Medical Director

AllCare Health

. Oversee day-to-day medical management activities, including utilization reviews, appeals and grievances, case consultations, and recommendations .

Posted 10/10/2026full-timeGrants Pass • Oregon • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medical Management, including utilization reviews, case consultations, and regulatory compliance. Proficient in developing and implementing medical policies and procedures while ensuring adherence to CMS, NCQA, and HIPAA standards.

Highest-signal resume keywords

Doctoral Degree (M.D. or D.O.)Five Years of Clinical ExperienceUtilization ManagementCMS Guidelines KnowledgeCurrent Oregon Medical License

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ReviewsCase ManagementClinical Service DeterminationsPolicy DevelopmentData AnalysisProject ManagementCPT Codes KnowledgeICD-10 Codes KnowledgeInterQual KnowledgeMilliman Care Guidelines Knowledge

Soft Skills

Effective CommunicationStress ManagementCustomer ServiceTeam CollaborationTime Management

Tools & Technologies

Microsoft Office SuiteRelias Learning Module System

Certifications & Qualifications

Current Board Certification in Designated Clinical FieldOregon Medical License

Industry Keywords

Healthcare IndustryRegulatory ComplianceAccreditation ComplianceQuality ImprovementService Recovery Best Practices

About the role

Key responsibilities & impact

Oversee day-to-day medical management activities, including utilization reviews, appeals and grievances, case consultations, and recommendations
Develop and maintain medical and departmental policies and procedures supporting utilization management
Work with the Chief Medical Officer to establish, implement, and monitor resource and cost utilization plans
Collaborate with medical, quality, compliance, and government-relations leaders to ensure regulatory and accreditation compliance
Make clinical service determinations based on medical appropriateness and applicable criteria and guidelines
Deny requests when medically necessary criteria, policy, or appropriateness requirements are not met
Lead or participate in corporate and community committees, task forces, and project initiatives
Serve as a subject matter expert in Medical Management and interpret regulatory requirements
Develop health plan departmental objectives and strategies with senior management
Coordinate development and annual review of medical policies, procedures, and standards for CMS, Oregon Health Plan, and NCQA requirements
Participate in credentialing, patient care, quality improvement, pharmacy, departmental, utilization management, and case review meetings
Support Medical Management staff activities and quality member care coordination
Optimize member experience and customer satisfaction
Serve as lead Medical Management liaison to independent physicians and other providers
Support physician recruitment and credentialing efforts
Refer appropriate situations to Quality Committee, Corporate Compliance, Fraud & Abuse, or Legal Services
Ensure compliance with confidentiality and HIPAA requirements
Participate in rotating weekend on-call coverage for emergent prior authorization requests
Maintain punctual, regular, and predictable attendance
Complete required training and perform other duties as assigned

Requirements

What you’ll need

Doctoral degree (M.D. or D.O.) or advanced practice license, such as Nurse Practitioner or Physician Assistant
Five years of clinical experience
Two years of previous experience in Utilization, Case and/or Disease Management or Wellness preferred
Knowledge of CMS Guidelines, CPT Codes, InterQual, HIPAA, ICD-10 Codes, Milliman Care Guidelines, and NCQA preferred
Current Oregon Medical License free of any restrictions or disciplinary action pending and able to legally and independently practice without supervision, or eligible to apply for an Oregon MD/DO/NP/PA license
Current board certification in the designated clinical field, as applicable
Valid Oregon driver’s license and proof of current vehicle insurance
Familiarity with the healthcare industry
Excellent computer skills, including Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel)
Knowledge of and compliance with HIPAA regulations
Knowledge of project management and/or change management
Knowledge of research methodologies and/or data analysis
Knowledge of customer service and service recovery best practices
Ability to handle multiple tasks within time constraints
Ability to handle stressful and dynamic work situations
Ability to work extended hours to resolve issues
Ability to communicate effectively with healthcare team members, members, families, and staff
Ability to perform essential duties with or without reasonable accommodation
Ability to work onsite for all scheduled shifts, work from a home office occasionally when needed, and travel locally as needed
Must meet required training, including Relias Learning Module System requirements

Benefits

Comp & perks

Competitive wages
Affordable healthcare
401k retirement
Wellness programs
Flexible schedule options
Mileage reimbursement for local travel
Cell phone stipend
Two 15-minute paid breaks