Pediatrician (Part-Time, Hybrid) - California

Gainwell Technologies LLC•Any city, OH

76d•$115,000 - $129,000•Hybrid

About The Position

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. In this role at Gainwell, you will contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve—particularly in communities most vulnerable—while working alongside teams focused on innovative, purpose-driven solutions.

Requirements

Board-certified or board-eligible physician specializing in pediatrics.
Minimum of three (3) years of clinical experience as a pediatrician.
A current California medical license.
Strong communication skills, as well as strong interpersonal and analytical skills.
Must reside within 35 miles of the Sacramento State Capitol, California.
Comfortable using the following applications: Word, Excel, and Outlook.

Responsibilities

Perform online reviews of medical documentation requiring the clinical expertise of a pediatric general practitioner.
Respond to medical claims, referrals, and inquiries from DHCS that require the expertise of a qualified pediatrician with a strong clinical background.
Respond to referrals from DHCS within four (4) hours of notification.
Review policy and attend meetings with DHCS.
Process suspended claims requiring expertise from a medical specialist and respond to referrals from internal departments.
Cross-train to help provide coverage for other consultants when required.