Medical Director (Part-Time) (Temporary)

Doctor of Medicine or Doctor of Osteopathy from an accredited medical school Current active and unrestricted license to practice medicine issued by the State of California Board certification in a specialty recognized by the American Board of Medical Specialties Minimum of three years of experience working in medical programs administration Experience with the peer review process Knowledge of data collection and management practices related to utilization and quality of medical care Knowledge of InterQual and Milliman Care Guidelines Knowledge of Managed care, Medi-Cal, Medicaid, and Medicare programs Knowledge of Healthcare regulatory processes Proficiency with Jiva (or equivalent)

Provide clinical leadership and oversight for Utilization Management (UM) Provide clinical leadership and oversight for Potential Quality Issue (PQI) Provide clinical leadership and oversight for Provider Disputes