Join a growing team of medical management professionals at one
of the fastest healthcare companies in the country.
Responsibilities include care management, medical appropriateness
reviews, and over 50% of the time representing company as a
clinical leader with providers, provider groups, local county
officials, and hospital systems. Will work on collaborative
projects around HEDIS and care coordination and help build
relationships. Primary duties include, but are not limited to: Meet
with providers and other health care stakeholders to build
relationships and execute collaborative projects
Interpret and administer company medical policies and clinical
Generates appropriate written correspondence to providers,
members, and regulatory entities.
Working closely with clinical and non-clinical staff to ensure
timely and consistent responses to members and providers.
Identify and develop opportunities to increase medical
management effectiveness and healthcare quality.
Serves as a resource and consultant to other areas of the
company including legal, compliance and medical operations
Liaison with external regulators including the CA Department of
Insurance and the CA Department of Managed Health Care.
May chair or serve on company committees
Review member grievances
Qualifications MD or DO
Requires current, unrestricted CA license to practice
Current ABMS recognized board certification required
At least 3-5 years of post-residency clinical experience
At least 3-5 years of medical utilization management experience
Requires at least an intermediate level of computer literacy
Ability to travel in Northern CA up to 30% required
Demonstrated Leadership/ External client experience
Competitive compensation with benefits offered.
Contact information :