SummaryThe Principal Medical Expert provides advanced clinical medicine expertise across a broad category of medical specialties, to include pediatric and adult medicine, occupational health, surgery, psychiatric, and basic obstetrics and gynecology. Board certified or board eligible physician with ten or more years of direct patient care experience across a broad spectrum of pediatric and adult medical specialties to perform online review of medical documentation requiring the expertise of a licensed physician with strong clinical experience.
The Principal Medical Expert provides advanced clinical medical expertise across a broad range of medical specialties to adjudicate complex medical claims, referrals, and appeals requiring the expertise of a physician with a strong background in direct clinical patient care.
Your role in our mission- The Principal Medical Expert is responsible for responding to referrals from DHCS within 4 hours of notification.
- Reviewing policy and attending meetings with DHCS
- Assist DHCS with development, and implementation of medical policy upon request.
- Respond to requests for review of records for medical justification from the Conlan Unit.
- Report suspected billing fraud.
- Review and adjudicate complex medical claims.
- Review and respond to referrals from internal departments requiring the knowledge of a license physician.
- Expect to cross train to help provide coverage for other consultants when required.
- Ensure timely claims adjudication and referral completion.
- Provide medical expertise across multiple divisions, ensuring accurate diagnosis, treatment protocols, and adherence to occupational health standards.
- Partner with senior leadership and cross-functional teams to assess program effectiveness and recommend improvements or alternative approaches.
- Contribute to division-wide, multidisciplinary initiatives requiring medical expertise; influence strategy and execution.
- Lead, develop, and manage team performance through coaching, training, and performance oversight.
What we're looking for- Current, active, unrestricted California medical license
- Board certification preferred
- Medical degree (Doctorate of Medicine or Doctorate of Osteopathy)
- 10+ years of progressive medical experience
- Experience with occupational health practices and procedures
- Experience with regulatory compliance, including OSHA and related guidelines
- Experience with policy development and implementation
- Experience with budget management and financial oversight
- Strong functional computer skills, including proficiency with Microsoft Outlook, Windows, and Excel
- Strong communication and presentation skills
- Demonstrated analytical and problem-solving capabilities
- Strong organizational skills with the ability to manage multiple priorities
- Proven leadership skills, including mentoring and developing others
What you should expect in this role- Hybrid work schedule.
- Must reside within 35 miles of the California State Capitol in Sacramento, CA
- Willingness to travel as needed
Applications will be accepted through October 15.
The pay range for this position is $121,700.00 - $173,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
