Medical Director, Part-Time (Remote)

Maximus is currently recruiting for a Medical Director! This position will support our DMHC Program. This is a part-time, fully remote position that can be located anywhere in the US.

The mission of the California Department of Managed Health Care (DMHC) is to protect consumers’ health care rights and ensure a stable health care delivery system. The DMHC accomplishes its mission by ensuring the health care system works for consumers. The Department protects the health care rights of more than 29.7 million Californians by regulating health care service plans, assisting consumers through a consumer Help Center, educating consumers on their rights and responsibilities, and preserving the financial stability of the managed health care system.

Essential Duties and Responsibilities

• Address clinical case questions from Appeals Officers and Administrative staff.
• Provide clinical advice and counsel to the internal team as needed, including assistance with identifying appropriate specialists for cases, addressing the sufficiency of panel physicians’ analyses, and addressing clinical questions.
• Communicate directly with panel physician reviewers as needed as part of the physician panel oversight function. This may be in the role of coaching, training, or even disciplinary actions.
• Vetting of potential panel physicians recruited by Provider Recruitment and Credentialing (PRC).
• Support the development of training materials for panel physicians and appeals officers.
• Perform quality reviews as requested by the client.
• Serve as the medical expert in ISO and URAC audits.
• Participate in quality improvement initiatives.
• Report to Senior Director or VP level.
• Medical degree (MD or DO) with board certification in an ABMS or AOA recognized specialty.
• At least 5 years of clinical patient care experience post-board certification.
• Licensure, current and unrestricted.
• Experience performing independent medical reviews or utilization reviews (at least one year of experience).
• Must be able to successfully pass credentialing requirements.
• Knowledge and application of medical management treatment guidelines.
• Comfortable reviewing the work of other physicians (all specialties).
• Windows-based computer skills including typing, word processing, presentation, and internet research.

Preferred Qualifications:

• Prior utilization review work experience in a managed care environment.
• Prior experience as a medical director in utilization review.
• Proficiency in conflict resolution.
• Experience with ISO and URAC certification audits.
• Licensure, current and unrestricted, to practice in the state of California.