IMCS Group
Job Title:
Medical Director Duration:
6-12 Months Contract Location:
Remote - CA Shift Type:
Mon – Fri 8am to 5pm Pay Range:
$120 to $130 per hour
Duties:
• Clinical Oversight- Lead all medical aspects of the program, ensuring decisions follow policies and best practices. Oversee clinical content of member communications and staff protocols to maintain high quality of care. • Medical Case Review - Evaluate and decide on complex cases such as Medical Exemption Requests and appeals. Provide timely, fair determinations for members seeking enrollment exceptions due to health conditions. • Protocol & Policy Development - Develop, implement, and update clinical guidelines, workflows, and training materials. Ensure the team is equipped with up-to-date medical guidelines and that enrollment processes are clinically sound. • Stakeholder Engagement - Act as the clinical point of contact with stakeholders: work closely with DHCS (state health officials), coordinate with health plans’ medical leadership, and consult with providers to resolve member issues and improve processes. • Quality Assurance - Monitor and enhance the quality of services from a clinical perspective. Review performance metrics and member outcomes, support compliance with contractual and regulatory standards, and spearhead continuous improvement efforts. • Staff Guidance - Advise and educate internal staff (enrolment counselors, customer service reps, nurses) on medical questions and scenarios. Provide training on health topics to strengthen the team’s ability to assist members appropriately. • Direct experience with Medi-Cal or other Medicaid programs, especially California’s managed care system. For example, having served as a Medical Director or consultant for a Medicaid health plan, or involvement in initiatives like utilization review or case management for Medicaid patients. Such background can help the candidate quickly understand and navigate the Enrollment Broker program’s context.
Education & Experience Required:
• MD or DO degree, Active California medical license • 7+ years of post-residency clinical practice • Board certified in a relevant specialty (e.g., Family Medicine, Internal Medicine, Pediatrics, or Preventive Medicine). Board certification signifies a higher level of expertise and is strongly preferred for this role. • Knowledge of Medicaid/Medi-Cal managed care principles and regulations • Strong leadership, communication, and decision-making skills; ability to collaborate with multi-disciplinary teams • Commitment to clinical quality, ethics, and compliance (HIPAA, etc.)
Note: The role is central to integrating clinical insight into an operational setting that helps Medicaid beneficiaries choose health plans. The Medical Director must balance clinical authority with collaborative teamwork, ensuring that the enrollment broker fulfills its obligations to members and the state with compassion and clinical excellence. Candidates should be prepared to operate in a public-sector environment, interfacing with state administrators and upholding the mission of the Medi-Cal program to provide equitable, high-quality healthcare access. The combination of strong clinical credentials, leadership experience, and a passion for public health will distinguish the ideal candidate for this important role.
Medical Director Duration:
6-12 Months Contract Location:
Remote - CA Shift Type:
Mon – Fri 8am to 5pm Pay Range:
$120 to $130 per hour
Duties:
• Clinical Oversight- Lead all medical aspects of the program, ensuring decisions follow policies and best practices. Oversee clinical content of member communications and staff protocols to maintain high quality of care. • Medical Case Review - Evaluate and decide on complex cases such as Medical Exemption Requests and appeals. Provide timely, fair determinations for members seeking enrollment exceptions due to health conditions. • Protocol & Policy Development - Develop, implement, and update clinical guidelines, workflows, and training materials. Ensure the team is equipped with up-to-date medical guidelines and that enrollment processes are clinically sound. • Stakeholder Engagement - Act as the clinical point of contact with stakeholders: work closely with DHCS (state health officials), coordinate with health plans’ medical leadership, and consult with providers to resolve member issues and improve processes. • Quality Assurance - Monitor and enhance the quality of services from a clinical perspective. Review performance metrics and member outcomes, support compliance with contractual and regulatory standards, and spearhead continuous improvement efforts. • Staff Guidance - Advise and educate internal staff (enrolment counselors, customer service reps, nurses) on medical questions and scenarios. Provide training on health topics to strengthen the team’s ability to assist members appropriately. • Direct experience with Medi-Cal or other Medicaid programs, especially California’s managed care system. For example, having served as a Medical Director or consultant for a Medicaid health plan, or involvement in initiatives like utilization review or case management for Medicaid patients. Such background can help the candidate quickly understand and navigate the Enrollment Broker program’s context.
Education & Experience Required:
• MD or DO degree, Active California medical license • 7+ years of post-residency clinical practice • Board certified in a relevant specialty (e.g., Family Medicine, Internal Medicine, Pediatrics, or Preventive Medicine). Board certification signifies a higher level of expertise and is strongly preferred for this role. • Knowledge of Medicaid/Medi-Cal managed care principles and regulations • Strong leadership, communication, and decision-making skills; ability to collaborate with multi-disciplinary teams • Commitment to clinical quality, ethics, and compliance (HIPAA, etc.)
Note: The role is central to integrating clinical insight into an operational setting that helps Medicaid beneficiaries choose health plans. The Medical Director must balance clinical authority with collaborative teamwork, ensuring that the enrollment broker fulfills its obligations to members and the state with compassion and clinical excellence. Candidates should be prepared to operate in a public-sector environment, interfacing with state administrators and upholding the mission of the Medi-Cal program to provide equitable, high-quality healthcare access. The combination of strong clinical credentials, leadership experience, and a passion for public health will distinguish the ideal candidate for this important role.