Job Description

Reporting to the Chief Medical Officer, this position will provide clinical leadership and oversight for key medical management functions, including Utilization Management (UM) and Potential Quality Issue (PQI), and Provider Disputes. This position will support our five service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa, California; you will be working fully remotely in California or the greater US with a valid California Board Certified Medical License. To be successful you will need knowledge of data collection and management practices, as related to utilization and quality of medical care, InterQual and Milliman Care Guidelines, managed care, Medi-Cal, Medicaid, and Medicare programs, and healthcare regulatory processes. You also need the ability to independently navigate complex systems to effectively and efficiently implement new programs in a timely manner, communicate clearly and consistently and work collaboratively with stakeholders and partners, such as patients, community-based organizations, and healthcare providers as well as to evaluate, qualitatively and quantitatively, a broad variety of programs and processes and use these evaluations to ensure ongoing quality improvement. Requires Doctor of Medicine or Doctor of Osteopathy from an accredited medical school and a current active and unrestricted license to practice medicine issued by the State of California.

About Central California Alliance for Health

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation.

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