Physician, Clinical Operations (Hybrid)

DirectShifts; California (MO); Hybrid; USD 180,000 - 240,000; Full time

Job summary

DirectShifts is seeking a full-time physician to join our CCHP Clinical Operations team, supporting day-to-day clinical operations and collaborating with UM and AGD departments.

The role reports to the Chief Medical Officer and includes participation in policy development, population health initiatives, and committee work, with an eight-hour day, five days a week, and a hybrid in-person requirement.

Responsibilities

• Evaluating authorization referrals that cannot be approved by a UM nurse
• Denying authorization requests and redirecting the member’s care as appropriate
• Reviewing referrals for out-of-network authorizations
• Reviewing tertiary center requests
• Serving as a resource for our UM team in clinical decision-making
• Reviewing member appeals and provider disputes of prior utilization management decisions
• Reviewing member grievances
• Assisting in the design and implementation of clinical guidelines
• Participating in policy development, implementation, and review
• Attending and participating in committees and meetings as needed
• Supporting CCHP efforts in Population Health Management (PHM)
• Assisting the Chief Medical Officer (CMO) and Medical Directors in overseeing clinical areas
• Fulfilling other roles and duties as assigned by the CCHP Leadership Team

Job description

DirectShifts is seeking a full-time physician to join our CCHP Clinical Operations team, supporting day-to-day clinical operations and collaborating with UM and AGD departments.

The role reports to the Chief Medical Officer and includes participation in policy development, population health initiatives, and committee work, with an eight-hour day, five days a week, and a hybrid in-person requirement.