Internal Medicine Physician

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🏄 California – Remote

🏄 California – Remote

💵 $152k - $217.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Serve as the physician subject matter expert for General Medicine and Internal Medicine services within Medicaid and government healthcare programs • Review complex authorization requests, appeals, and medical necessity determinations across inpatient, outpatient, post-acute, and specialty care settings • Conduct peer-to-peer consultations with treating providers and apply evidence-based clinical criteria to support appropriate care decisions • Provide clinical guidance to utilization management, care management, quality improvement, and operational teams • Interpret and apply Medicaid regulations, medical policies, and nationally recognized clinical guidelines • Collaborate with clients, providers, and internal stakeholders to improve healthcare outcomes, quality initiatives, and member access to appropriate care • Support development and maintenance of clinical policies, review guidelines, and utilization management strategies • Participate in complex case reviews and multidisciplinary discussions involving high-risk or medically complex populations • Review clinical documentation, utilization management activities, appeals, and quality-of-care assessments • Interact frequently with physicians, providers, clients, and multidisciplinary healthcare teams

🎯 Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) • Active, unrestricted U.S. medical license • Active, unrestricted license to practice medicine in the State of California • Board Certification in Internal Medicine, Family Medicine, or a related primary care specialty • Minimum of five years of post-residency clinical practice experience in Internal Medicine, General Medicine, hospital medicine, or related patient care settings • Strong knowledge of evidence-based medicine, chronic disease management, and care delivery across diverse patient populations • Knowledge of nationally recognized clinical guidelines and healthcare quality standards • Ability to work independently in a remote environment • Experience with Medicaid programs, utilization management, prior authorization, appeals, quality review, or medical necessity determinations preferred • Experience conducting physician peer-to-peer reviews and collaborating with multidisciplinary clinical teams preferred • Excellent analytical, communication, and decision-making skills

🏖️ Benefits

• Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Flexible work options • Career development opportunities