Internal Medicine Physician- California

Gainwell Technologies LLC•Any city, OH

2d•$152,000 - $217,200•Remote

About The Position

The Internal Medical Physician serves as a senior clinical subject matter expert responsible for providing medical oversight and review of healthcare services across a broad range of medical conditions and treatment settings. This role partners with clinical, operational, and client teams to ensure medical necessity determinations are evidence-based, clinically appropriate, and aligned with state Medicaid regulations and program requirements. The Internal Medical Physician supports quality improvement initiatives, provider engagement, policy development, and clinical consultation activities to improve healthcare outcomes and ensure appropriate utilization of services.

Requirements

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an 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.
Minimum of five years of post-residency clinical practice experience in Internal Medicine, General Medicine, hospital medicine, or related patient care settings.
Strong knowledge of evidence-based medicine, chronic disease management, and care delivery across diverse patient populations.
Knowledge of nationally recognized clinical guidelines and healthcare quality standards.
Excellent analytical, communication, and decision-making skills, with the ability to work independently in a remote environment.

Nice To Haves

Experience with Medicaid programs, utilization management, prior authorization, appeals, quality review, or medical necessity determinations preferred.
Experience conducting physician peer-to-peer reviews and collaborating with multidisciplinary clinical teams preferred.

Responsibilities

Serve as the physician subject matter expert for General Medicine and Internal Medicine services within Medicaid and government healthcare programs.
Review complex authorization requests, appeals, and medical necessity determinations across inpatient, outpatient, post-acute, and specialty care settings.
Conduct peer-to-peer consultations with treating providers and apply evidence-based clinical criteria to support appropriate care decisions.
Provide clinical guidance to utilization management, care management, quality improvement, and operational teams.
Interpret and apply Medicaid regulations, medical policies, and nationally recognized clinical guidelines to support program compliance.
Collaborate with clients, providers, and internal stakeholders to improve healthcare outcomes, quality initiatives, and member access to appropriate care.
Support development and maintenance of clinical policies, review guidelines, and utilization management strategies.
Participate in complex case reviews and multidisciplinary discussions involving high-risk or medically complex populations.