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Company Info

American Specialty Health
San Diego, CA, United States

Company Profile

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Medical Director, Rehabilitative Services - San Diego-CA, Southlake-TX, Carmel-IN


Job ID:



San Diego-CA, Southlake-TX, Carmel-IN 

Job Category:

Health Care, Management, Professional Services



Employment Type:

Full Time



Job Description:

Medical Director, Rehabilitative Services

American Specialty Health, Inc. is seeking an Medical Director, Rehabilitative Services for our clinical quality evaluation department. The primary purpose of this position is to assist in the management of department functions within the organization as directed by VP and Medical Director, Health Services and operates within the Clinical Quality Evaluation teams. Principal responsibility is the ongoing management of clinical transactions and related activities of the Rehabilitation Services CQE and CQA functions.


  • Provide clinical decision-making and supports staff who also provide clinical decision-making in support of credentialing, medical necessity review (Utilization Review/Utilization Management) quality assurance, quality improvement, and medical necessity verification activities.
  • Accountable for all activities within assigned scope of authority. Ensures accuracy and productivity in project development and completion, and works cooperatively with all internal and external contacts.
  • Responsible for making medical management UM decisions when required by State regulation, delegation, appeals.
  • Responsible for the day-to-day activities that produce the quality, efficiency and effectiveness of the Rehabilitation Services review program.
  • Hiring, oversight, training, and ongoing development of Team Leads and CQE staff.
  • Supports ongoing Rehabilitation Services program development and client implementation
  • Supports Sales Department and Client Services in efforts relative to Rehabilitation Services program sales, member or client issues and data analysis as directed.
  • Manages escalated issues and correspondence with HP Medical Director(s) related to PT-OT-ST.
  • Supports Provider Education content development and delivery as well as interaction with existing large providers.
  • Provides health coaching support as needed for EmpoweredDecsions health management program.
  • Supports clinical credentialing and medical record review as identified to meet ASH deliverables and client expectations
  • Supports Sr. Manager CQA regarding clinical investigation of credentialing, verification of medical necessity, and quality of care issues for presentation to committees as requested
  • Supports utilization management activities as directed, including file review as needed based on report quantity, turnaround time constraints, PTO, and other potential issues that may arise
  • Supports clinical program, policy, guideline, and protocol development and implementation
  • Assists and participates in quality committees and CCC as appropriate.
  • Serves as chair or co-chair of professional advisory committees related to Rehabilitation Services specialties.
  • Assists in regulatory, accreditation, health plan, and medical group audits as required
  • Supports external health plan, vendor, or other external consultants as directed.
  • Interacts with external clinicians including medical directors, disease management staff rehabilitation therapy directors at contracted clinics and with clients.
  • Attends meetings with external customers when assigned
  • Interacts with MNA to identify process improvements and efficiencies including participation in Key Process Development Team. 
  • Acts as liaison between CQE staff and administrative staff. 
  • Supports the research and development of clinical content, guidelines, policies, and protocols as necessary
  • Supports research and health care and clinical content writing as directed
  • Supports Health Services strategic planning and resource management including ensuring department is adequately trained and staffed to ensure performance standards are met and regulatory and accreditation standards are met.
  • Assists in management reporting and creates presentations as required to communicate the stability and success of the Rehabilitation Services program
  • Prepares and is available for external presentations, including travel outside of California
  • Performs other duties and responsibilities as assigned
 computer skills.

Job Requirements:


  • Graduate of an accredited medical college in the US and Board certified required. 
  • Must have a current, unrestricted medical license in the United States and be able to obtain, and willing and able to maintain, state medical licenses in other states as requested by company.
  • Medical or Osteopathic Physician with demonstrated experience in musculoskeletal medicine   (required).
  • Physical Therapy knowledge (required).
  • All clinical credentials are active and good standing with State Board
  • At least 5 years of Clinical practice experience required.
  • Competent  understanding of transactional UM systems and processes
  • Experience as medical director for a full-service medical health plan / insurance company preferred
  • Supervisory experience. 
  • Experience in Medical Necessity Review, Clinical Quality Management
  • General understanding of aspects of Complementary Health Care preferred.
  • Valid driver’s license with good driving record.  Availability of automobile for on the job use and proof of insurance.
  • Excellent communication skills

Security Clearance:

NO Security Clearance

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