Principal Medical Expert

Gainwell Technologies LLC•Any city, OH

1d•$121,700 - $173,800•Hybrid

About The Position

The 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.

Requirements

Current, active, unrestricted California medical license
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

Nice To Haves

Board certification preferred

Responsibilities

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.