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Medical Director

Fresno, CA · Healthcare
Join a growing team of medical management professionals at one of the fastest healthcare companies in the country. 
Responsibilities include care management, medical appropriateness reviews, and over 50% of the time representing company as a clinical leader with providers, provider groups, local county officials, and hospital systems.  Will work on collaborative projects around HEDIS and care coordination and help build relationships.
Primary duties include, but are not limited to:  
  • Meet with providers and other health care stakeholders to build relationships and execute collaborative projects
  • Interpret and administer company medical policies and clinical guidelines
  • Generates appropriate written correspondence to providers, members, and regulatory entities.
  • Working closely with clinical and non-clinical staff to ensure timely and consistent responses to members and providers.
  • Identify and develop opportunities to increase medical management effectiveness and healthcare quality.
  • Serves as a resource and consultant to other areas of the company including legal, compliance and medical operations
  • Liaison with external regulators including the CA Department of Insurance and the CA Department of Managed Health Care.
  • May chair or serve on company committees
  • Review member grievances
  • MD or DO
  • Requires current, unrestricted CA license to practice medicine
  • Current ABMS recognized board certification required 
  • At least 3-5 years of post-residency clinical experience required
  • At least 3-5 years of medical utilization management experience required 
  • Requires at least an intermediate level of computer literacy 
  • Ability to travel in Northern CA up to 30% required
  • Demonstrated Leadership/ External client experience preferred 
Competitive compensation with benefits offered.
Contact information:
Max Populi, LLC
4628 Bayard Street, #207
Pittsburgh, PA 15213-2750
Tel: (412) 567-5279
Fax: (412) 567-5198
e-mail: jobs@maxpopuli.com

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