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Medical Director

Health Plan of San Mateo


Location:
South San Francisco, California 94080
Date:
09/25/2018
2018-09-252018-10-25
Work Type:
Employee
Job Status:
Full Time
Specialties:
  • Internal Medicine
Health Plan of San Mateo
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Job Details

 

The Health Plan of San Mateo (HPSM) is a local non-profit health care plan that offers health coverage and a provider network to San Mateo County's underinsured population. We are a community-based health plan with a vision that Healthy is for Everyone – and we fight to make that possible.  By partnering with providers and community organizations, we are able to advocate for the health of our members and meet the highest standards for quality of care.


HPSM is are currently seeking a qualified medical professional to join our team as a Medical Director.   HPSM offers its employees an exceptional benefits package  including: HPSM paid premiums for employee’s Medical, Dental and Vision coverage.  Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits.  Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

 

Essential functions of this position 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 process as necessary.

  • Provide clinical support to Pharmacy department as appropriate.

  • Provide clinical input for specific programs as appropriate including recommendations for care plans.

Requirements

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 Drivers License, transportation, and auto liability insurance.
  • Minimum of five (5) years of experience working in medical programs administration.
  • Experience with Medi-Cal and Medicare programs
  • Experience working with systematic quality assurance and improvement programs preferred.
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