Internal Medicine Physician

This is a fully remote position, open to applicants in California.

📋 Description

• Act as the physician subject matter expert for General Medicine and Internal Medicine services within Medicaid and governmental healthcare programs.

• Evaluate intricate authorization requests, appeals, and medical necessity assessments across inpatient, outpatient, post-acute, and specialty care environments.

• Engage in peer-to-peer consultations with treating providers and implement evidence-based clinical criteria to facilitate appropriate care decisions.

• Offer clinical direction to utilization management, care management, quality improvement, and operational teams.

• Interpret and apply Medicaid regulations, medical policies, and widely recognized clinical guidelines.

• Collaborate with clients, providers, and internal stakeholders to enhance healthcare outcomes, quality initiatives, and member access to suitable care.

• Assist in the development and maintenance of clinical policies, review guidelines, and utilization management strategies.

• Participate in intricate case reviews and multidisciplinary discussions involving high-risk or medically complex populations.

• Review clinical documentation, utilization management activities, appeals, and quality-of-care evaluations.

• Frequently interact with physicians, providers, clients, and multidisciplinary healthcare teams.

⛳️ Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).

• Active, unrestricted U.S. medical license.

• Active, unrestricted license to practice medicine in the State of California.

• Board Certification in Internal Medicine, Family Medicine, or a related primary care specialty.

• A minimum of five years of post-residency clinical practice experience in Internal Medicine, General Medicine, hospital medicine, or related patient care settings.

• Strong understanding of evidence-based medicine, chronic disease management, and care delivery across various patient populations.

• Familiarity with nationally recognized clinical guidelines and healthcare quality standards.

• Ability to work autonomously in a remote setting.

• Preferred experience with Medicaid programs, utilization management, prior authorization, appeals, quality review, or medical necessity evaluations.

• Preferred experience in conducting physician peer-to-peer reviews and collaborating with multidisciplinary clinical teams.

• Exceptional analytical, communication, and decision-making abilities.

🏝️ Benefits

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Flexible work options.

• Career development opportunities.