Under direction, (1) in a region or district office, to give professional advice and guidance on the medical aspects of one of the Department's programs; or (2) in a small district office, to act as district administrator responsible for one of the Department's programs; or (3) in a staff capacity, to assist in the review of the work of the field to assure uniformity and quality of decisions and in the development of policies and standards relative to the Department's programs; and to do other related work.
In a region or district office, reviews and approves medical treatment or examination.authorization requests; advises on medical aspects of the various programs; interprets medical criteria related to prior authorization and medical care benefits to medical and other allied groups in the community; reviews case histories, evaluates and interprets medical reports; evaluates potential effects of medical and surgical treatments; works closely with review committees of local medical societies; advises and consults with other agencies on scope of benefits, utilization controls, and payment for services covered by the various programs; establishes and maintains effective working relation ships with individual physicians, medical societies, county health and welfare agencies, and other organizations concerned with health care; advises on the medical aspects of the work of the medical-social review team as it relates to nursing home care; as required, acts as a member of the medical-social review team; makes recommendations for modification of medical services and for more effective utilization of community resources; reviews medical treatment plans and recommends appropriate action; addresses professional and lay groups; prepares reports.
As district administrator, directs overall administration of the program of consultation, prior authorization, surveillance, coordination, and planning activities in the district; assesses local needs and suggests programs to meet those needs; directs staff in the various professional functions; directs and assists in the development of methods for implementing program controls related to prior authorization, utilization review and related activities; coordinates with medical and dental groups, professional health organizations and associations; interprets programs; promotes continuity and quality of care for beneficiaries; directs surveillance activities; coordinates and develops liaison with local welfare departments and other agencies; promotes prompt and efficient handling of prior authorization requests, consultative services, and utilization review activities.
In a staff capacity, assists in developing policies, standards, and guides on administration of the medical aspects of the Department's programs to assure compliance with State and Federal regulations; assists in analyses and preparation of reports concerning proposed legislation affecting the Department's programs; provides technical advice to committees; consults with statewide professional organizations, community groups, public officials, Department staff, and others on the medical phases of the programs; assists in establishing and maintaining liaison and cooperative relationships with the medical profession and allied groups, provider organizations, advisory committees and other public and private agencies engaged in health and medical services; assists in evaluating reports on medical aspects of locally administered programs and suggests courses of action; assists in investigations of providers and recommends disciplinary action when appropriate; conducts studies and prepares reports; addresses professional and lay groups.
Possession of the legal requirements for the practice of medicine in California as determined by the California Board of Medical Quality Assurance or the California Board of Osteopathic Examiners. (Applicants who are in the process of securing approval by the Board of Medical Quality Assurance or the Board of Osteopathic Examiners will be admitted to the examination, but the Board to which application is made must determine that all legal requirements have been met before candidates will be eligible for appointment.) and One year of experience in the practice of medicine exclusive of the internship.
Knowledge of: Principles and practices of general medicine and surgery with particular reference to the techniques and trends in the diagnosis of physical and mental handicaps and in treatment programs for such handicaps; interrelationships of Federal, State, and local professional and voluntary public health and welfare agencies and of the programs and services of such agencies; principles of community organization and skill in their application; principles of preventive medicine; Department's Affirmative Action Program objectives; a manager's role in the Affirmative Action Program and the processes available to meet affirmative action objectives.
Ability to: Interpret and apply the medical policies and standards of the Department's program of medical care; promote the organization of community health resources and their effective utilization in a medical care program; analyze situations accurately and take effective action; establish and maintain cooperative relations with those contacted in the work; write effectively; speak effectively before professional and lay groups; effectively contribute to the Department's affirmative action objectives.