Remote Medical Director Consultant: Quality & Care Strategy

SAN JOAQUIN COUNTY HEALTH COMMISSION; Modesto (CA); Remote; USD 210,000 - 270,000; Full time

Job summary

Health Plan of San Joaquin is seeking a physician leader for a consultant Medical Director role, remote in California. You will provide clinical oversight for utilization, quality, pharmacy, credentialing, and health equity to ensure quality, cost-effective care aligned with contracts and accreditation standards.

You will lead medical management, grievance and appeals oversight, and collaborate with the Deputy CMO to address service issues and develop action plans.

Qualifications

• MD degree from an accredited medical school.
• Satisfactory completion of an American Council of Graduate Medical Education accredited residency program.
• At least five years clinical experience in the practice of medicine in a managed care setting; and
• At least five years supervisory experience in a healthcare setting; or an equivalent combination of experience.

Responsibilities

• Provides clinical leadership for medical management functions; assists subordinate managers in resolving medical claims review, grievances, appeals, and other medical management issues.
• Identifies medical service issues and develops action plans with the Deputy CMO; monitors results.
• Conducts clinical reviews and UM decisions for prior, concurrent, and retro authorizations, and appeals; follows medical review criteria for Medi-Cal and DSNP members.
• Works with stakeholders to improve care and services; identifies opportunities for improvement.
• Represents the health plan in the community and supports budgeting and metrics development.

Skills

Strategic mindset

Budget management

Collaboration

Communication skills

Decision quality

Project management

Education

MD degree

Residency (ACGME accredited)

Board Certification

California Medical License

Tools

Word

Excel

Job description

Health Plan of San Joaquin is seeking a physician leader for a consultant Medical Director role, remote in California. You will provide clinical oversight for utilization, quality, pharmacy, credentialing, and health equity to ensure quality, cost-effective care aligned with contracts and accreditation standards.

You will lead medical management, grievance and appeals oversight, and collaborate with the Deputy CMO to address service issues and develop action plans.