California Licensed Medical Director

Job Summary

Providing clinical oversight for utilization, quality, pharmacy, and credentialing functions, the part-time California Licensed Medical Director will manage complex medical management issues and collaborate with leadership to ensure compliance and improve healthcare delivery in a remote setting.

Key responsibilities

• Oversee medical management functions, including claims review, grievances, and appeals
• Identify and analyze care quality issues, making recommendations for improvements
• Conduct clinical reviews and make utilization management decisions for Medi-Cal and DSNP members

Required qualifications

• MD degree from an accredited medical school and completion of a residency program
• Minimum five years of clinical experience in a managed care setting, with experience in Medi-Cal and/or Medicare populations
• Unrestricted California medical license and board certification in a chosen specialty
• At least five years of supervisory experience in a healthcare setting
• In-depth knowledge of managed care principles and healthcare issues affecting underserved populations