Under general direction, (1) in a region or large district office, to give professional advice and guidance on the medical aspects of one of the Department's programs and to direct and coordinate the work of a group of medical consultants and technical staff; or (2) in a staff capacity, to review the work of the field offices to assure the quality and uniformity of decisions and to provide technical guidance to consultants in the field, and providers, beneficiaries, medical societies, community organizations, or participate in the implementation and interpretation of State and Federal laws. the formulation of State laws, regulations, policies, and procedures relating to medical aspects of departmental programs; and to do other related work.
Coordinates and directs the medical prior authorization, consultation, and liaison activities of a staff of medical consultants; recruits and selects staff; plans and provides necessary training; evaluates their work and takes or recommends appropriate action; provides professional advice and guidance; makes final determinations on prior authorization approvals for the region and for districts in that region as requested; reviews denials or prior authorization requests; evaluates utilization patterns, identifies providers where increased surveillance may be required, and recommends investigations when indicated; interprets program regulations for medical services to medical societies and other provider groups; works closely with local medical societies, the medical profession and allied groups, provider organizations, advisory committees, and public and private agencies engaged in health services; makes recommendations for changes in the rules and regulations of various programs; participates in special projects and studies; 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 of their qualifications 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 Either I One year of experience in California state service performing the duties of a Medical Consultant I, Department of Health Services.
Three years of experience in the practice of medicine (exclusive of internship) including one year of administrative, supervisory, or consultant experience in a public health or welfare agency or in a medical care or rehabilitative program.
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 the programs and services of such agencies; principles of preventive medicine; principles of community organization; principles and practices of personnel management; 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: Direct the work of a group of medical consultants; interpret and apply the medical policies standards, rules, and regulations of the Department s program; evaluate the quality and scope of medical services provided by the Medi-Cal 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.
Willingness to travel.