Our client, one of the nation’s leading health benefits companies, seeks a Medical Director to join a group that is being formed to support members enrolled in the Medicaid Program. Based in Northern California, this medical director will be responsible for the administration of medical management services for company health plans and ensuring the clinical integrity of broad and significant clinical programs, including the overall medical policies of the Medicaid business unit.

Responsibilities include care management, medical appropriateness reviews, and over 50% of the time representing our client as a clinical leader with providers, provider groups, local county officials, and hospital systems.

Primary duties include, but are not limited to:

• Meet with providers and other health care stakeholders to build relationships and execute collaborative projects
• Interpret and administer company medical policies and clinical guidelines
• Generates appropriate written correspondence to providers, members, and regulatory entities.
• Working closely with clinical and non-clinical staff to ensure timely and consistent responses to members and providers.
• Identify and develop opportunities to increase medical management effectiveness and healthcare quality.
• Serves as a resource and consultant to other areas of the company including legal, compliance and medical operations
• Liaison with external regulators including the CA Department of Insurance and the CA Department of Managed Health Care.
• May chair or serve on company committees
• Review member grievances

Qualifications:

• MD or DO
• Requires current, unrestricted CA license to practice medicine
• Current ABMS recognized board certification required
• At least 3-5 years of post-residency clinical experience required

• At least 3-5 years of managed care experience required
• Ability to travel in Northern CA up to 30% required

Join us and together we will drive the future of healthcare.