Remote Medical Consultant I – Medi-Cal TAR Specialist

California Department of Health Care Services; California; Remote; USD 149,000 - 221,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Paid holidays and vacation

Retirement program

Telework

Job summary

The California Department of Health Care Services is seeking a Medical Consultant I to review Treatment Authorization Requests (TARs) and medical records for Medi-Cal beneficiaries. Under the supervision of the Medical Consultant II, you will provide medical adjudication support to field offices and headquarters nursing staff.

This role requires statewide travel up to 5% for trainings and meetings; telework is available.

Responsibilities

• Reviews Treatment Authorization Requests (TARs) and medical records for Medi-Cal beneficiaries.
• Provides medical consultation to field office and headquarters nursing staff for TAR adjudications.
• May review Appeals, Disputes and Litigation and represent the Department at Fair Hearings and Administrative Hearings.
• May work on special projects involving medical chart reviews and quality assurance.

Job description

The California Department of Health Care Services is seeking a Medical Consultant I to review Treatment Authorization Requests (TARs) and medical records for Medi-Cal beneficiaries. Under the supervision of the Medical Consultant II, you will provide medical adjudication support to field offices and headquarters nursing staff.

This role requires statewide travel up to 5% for trainings and meetings; telework is available.