Remote Medical Director Consultant — Quality & Utilization

HPSJ

Northern (KY)

Ibrido

USD 170.000 - 243.000

Tempo pieno

11 ore fa

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Descrizione del lavoro

Health Plan of San Joaquin is seeking a consultant Medical Director to provide clinical oversight across utilization, quality, and credentialing functions. This remote role requires California residency and supports a focus on quality of care and health equity.

The Medical Director will lead medical management, collaborate with the Deputy CMO, and guide reviews for prior, concurrent, and retro authorizations, ensuring regulatory compliance and cost-effective care.

Competenze

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 a managed care setting with Medi‑Cal/Medicare populations.
Unrestricted medical license in the state of California.
Board Certification in a chosen specialty.

Mansioni

Provides clinical leadership for medical management functions and resolves issues related to claims review, grievances, and quality of care.
Collaborates with the Deputy CMO to identify service issues and develop action plans.
Identifies care and quality trends and implements changes.
Conducts clinical reviews for prior, concurrent, and retro authorizations and appeals.
Represents HPSJ in committees and external stakeholder engagements.