Medical Director, South San Francisco, CA
(Temporary, Part-time or On-Call)
The Health Plan is seeking a qualified medical professional to assist in areas of utilization management, care coordination design and execution of quality activities.
Essential Functions Include:
- Review and make determinations on authorization requests referred by staff; participate in staged resolution of authorization appeals.
- Evaluate member requests for administrative membership categories.
- Evaluate physician requests for member reassignment.
- Conduct hospital concurrent reviews
- Participate in the design of quality improvement studies, plans and efforts.
- Participate in the HPSM grievance and appeals policy as necessary.
- Provide clinical support to Pharmacy Department as appropriate.
- Provide clinical input for specific programs as appropriate including recommendations for care plans.
The ideal candidate should have the following skills and qualifications:
- Valid and unrestricted license as a medical doctor (M.D.) by the Medical Board of California.
- Board Certification in Internal Medicine or a comparable specialty recognized by the American Board of Medical Specialties preferred.
- Valid California Driver’s License, transportation, and automobile liability insurance in limits acceptable to HPSM
- Minimum of five (5) years of experience working in medical programs administration with at least two (2) years in a management role.
- Experience with Medi-Cal and Medicare programs.
- Experience working with systematic quality assurance and improvement programs preferred
Compensation: $125 per hour
This opportunity is temporary, part-time or/and on-call with an initial estimate of 3-6 months but may be extended based on business needs. Hours of work may fluctuate from part-time to full-time depending on the workload during any given time period. Flexibility to work onsite or remotely may be considered.
To be considered for this opportunity you can email your resume along with a cover letter to:
or fax or Mail you resume to:
Health Plan of San Mateo
Human Resources Department
801 Gateway Blvd.,
South San Francisco, CA 94080
Fax 650 616-8039