Remote Medical Director Consultant: Health Plan Oversight

SAN JOAQUIN COUNTY HEALTH COMMISSION; French Camp (CA); Remote; USD 150,000 - 190,000; Full time

Job summary

Health Plan of San Joaquin is seeking a Medical Director consultant to provide clinical oversight of utilization management, quality, pharmacy, credentialing and health equity functions while ensuring cost-effective care. The role supports grievances and quality of care investigations with independent judgment.

The position is remote and requires residence in California, with collaboration across committees and leadership to meet regulatory requirements and organizational goals.

Qualifications

• Experience in managed care and medical management settings.
• Knowledge of Medi-Cal and Medicare populations.
• Experience supervising healthcare teams.

Responsibilities

• Provide clinical oversight of utilization management, quality, pharmacy, credentialing and health equity.
• Lead medical reviews for prior, concurrent and retro authorizations.
• Collaborate with leadership to ensure regulatory and accreditation compliance.
• Represent Health Plan in committees and stakeholder interactions.

Skills

Clinical leadership

Utilization management

Quality improvement

Quality metrics

Budget development

Communication

Strategic thinking

Project management

English proficiency

Confidential handling

Education

MD degree

Residency (ACGME)

Public Health Master's substitution

Job description

Health Plan of San Joaquin is seeking a Medical Director consultant to provide clinical oversight of utilization management, quality, pharmacy, credentialing and health equity functions while ensuring cost-effective care. The role supports grievances and quality of care investigations with independent judgment.

The position is remote and requires residence in California, with collaboration across committees and leadership to meet regulatory requirements and organizational goals.