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Gainwell Technologies · 8 hours ago

Pediatrician (Part-Time) - California

Any city, CA, US, 99999

Full-time, Part-time

Hybrid

Mid Level

$115K/yr - $129K/yr

3+ years exp

Gainwell Technologies is seeking a part-time Pediatrician to join their Medical Review team. In this role, the pediatrician will perform online reviews of medical documentation and respond to medical claims and referrals requiring pediatric expertise, contributing to the health and well-being of vulnerable communities.

Health CareInformation Technology

Responsibilities

This position is a part-time (20 hours), contractual-required role for the Medi-Cal MMIS account for the Department of Health Care Services (DHCS)

As a member of the Medical Review team, you will use your clinical knowledge and acumen to respond to medical claims, referrals, and inquiries from DHCS that require the expertise of a qualified pediatrician with a strong clinical background

The Medical Review Pediatrician is responsible for responding to referrals from DHCS within four (4) hours of notification

Reviewing policy and attending meetings with DHCS

Processing suspended claims requiring expertise from a medical specialist and responding to referrals from internal departments

Hybrid work environment. This is primarily a remote position. Occasionally, upon client request, the consultant will travel to the Medicaid Operations Center (MOC) located in West Sacramento

Expected to cross-train to help provide coverage for other consultants when required

Qualification

PediatricsCalifornia medical licenseClinical experienceAnalytical skillsMicrosoft WordMicrosoft ExcelMicrosoft OutlookCommunication skillsInterpersonal skills