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 decisions
• Supporting our AGD team by reviewing member grievances
• Assisting in the design and implementation of clinical guidelines
• Participating in policy development, implementation, and review
• Attending and participating in committees and meetings as needed
• Supporting 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 Plan
• Fulfilling other roles and duties as assigned by the CCHP Leadership Team

The 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.