The Position
Contra Costa Health Plan (CCHP) has been serving the health needs for people in Contra Costa County for almost 50 years. CCHP was the first federally qualified, state-licensed, county-sponsored HMO in the United States. In 1973, CCHP became the first county-sponsored health plan in California to offer Medi-Cal Managed Care coverage. In 2024, Contra Costa Health Plan will be part of the Single Plan Model for Medi-Cal Managed Care in Contra Costa County. At CCHP, we serve over 300,000 people and offer comprehensive, quality health coverage.
Our CCHP Clinical Operations team includes the following departments:
- Utilization Management (UM)
- Appeals and Grievances Department (AGD)
- Clinical Quality Auditing
- Pharmacy
- Advice Nurse Unit
- Case Management
Physician Role:
The full-time physician is an essential member of the CCHP team who supports day to day clinical operations of the organization. Responsibilities include, but are not limited to:
- Supporting our Utilization Management team by participating in the UM review process:
- Evaluating authorization referrals that cannot be approved by a UM nurse
- Denying authorization requests and redirecting the member’s care as appropriate
- Reviewing referrals for out-of-network authorizations
- Reviewing tertiary center requests
- Serving as a resource for our UM team in clinical decision-making
Supporting our AGD team by reviewing member appeals and provider disputes of prior utilization management decisionsSupporting our AGD team by reviewing member grievancesAssisting in the design and implementation of clinical guidelinesParticipating in policy development, implementation, and reviewAttending and participating in committees and meetings as neededSupporting CCHP efforts in Population Health Management (PHM)Assisting the Chief Medical Officer (CMO) and Medical Directors in overseeing and providing medical expertise to the clinical areas of the Health PlanFulfilling other roles and duties as assigned by the CCHP Leadership TeamThe full-time physician will report to the Chief Medical Officer (CMO).
Hours:
Eight hours a day. Five days a week. Hybrid position, with in-person component. May include weekends as mutually agreeable between the physician and CCHP leadership.
Selection Process
Interested individuals should submit a resume and cover letter to
Irene.Lo@cchealth.org . Those candidates deemed most qualified will be invited to interview.
This position is exempted from the merit system and will not follow regular County recruitment and selection procedures. Not all applicants will be invited to participate in the evaluation and interview process.
To find more information on Benefits offered by Contra Costa County, please go to https://www.contracosta.ca.gov/1343/Employee-Benefits
