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French Camp

    Medical Director - French Camp, United States - The Ladders

    The Ladders
    The Ladders French Camp, United States

    1 week ago

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    Description

    Job Title: Medical Director at Health Plan of San Joaquin



    The pay range for this position varies depending on factors like location, experience, and education, and is subject to change.



    What You Will Be Doing:
    • Providing clinical oversight for the utilization, quality, pharmacy, and credentialing functions to ensure the delivery of cost-effective healthcare
    • Supporting grievances and appeals team in clinical oversight of care investigations and resolutions
    • Working on complex tasks requiring high discretion and judgment


    About the Company:


    Health Plan of San Joaquin (HPSJ) is dedicated to improving community health through value-based healthcare and partnerships within the community.


    Our Vision: Continuously improve the health of our community.


    Our Mission: Provide healthcare value and advance wellness through community partnerships.



    Essential Functions:
    • Lead medical management functions and resolve medical claims
    • Collaborate with Chief Medical Officer to address medical service issues
    • Analyze care trends, develop recommendations, and implement changes
    • Conduct clinical reviews, make authorization decisions, and handle grievances
    • Establish and maintain relationships with providers and stakeholders
    • Ensure medical compliance with regulations and internal requirements
    • Contribute to policy development and budget management


    What You Bring:
    • In-depth knowledge of managed care principles and healthcare issues
    • Strong financial acumen, decision-making, and strategic thinking skills
    • Ability to lead and collaborate effectively with diverse stakeholders
    • Excellent communication and presentation skills
    • Skills in managing projects, handling ambiguity, and promoting organizational values


    Education and Experience:
    • MD degree from an accredited medical school
    • Five years of clinical experience related to managed care
    • Supervisory experience in a healthcare setting
    • Required licenses and certifications


    What You Will Get:
    HPSJ Perks:
    • Competitive salary
    • Comprehensive health/dental/vision benefits
    • Generous paid time off and retirement programs
    • Flexible spending accounts and insurance coverage
    • Access to education and training reimbursement
    • A rewarding mission-focused work environment
    • Equal opportunity employment with a focus on diversity and inclusion


    Important Notice:

    This job description does not constitute a contract and duties may change at the discretion of HPSJ.


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