PHYSICIAN SPECIALIST (NON-MEGAFLEX)

  • LOS ANGELES COUNTY
  • Los Angeles, California
  • Apr 04, 2018
Full Time Public Health

Job Description



DEPARTMENT OF PUBLIC HEALTH
TRANSFER OPPORTUNITY ANNOUNCEMENT
TRPH54761


VACANCY INFORMATION

Children's Medical Services
California Children's Services
Medical Administration
9320 Telstar Avenue
El Monte, CA 91731

•Free employee parking is provided.
•This position is eligible for a 9/80 work schedule.
•Onsite employee-paid Montessori childcare center is available.
•County Wellness Program activities (e.g., Zumba classes) are offered onsite.
•Public transportation services are in close proximity.

Essential Job Functions

The Physician Specialist for the Children's Medical Services (CMS) California Children's Services (CCS) program oversees case management for CCS patients through the age of 21 years, determines medical eligibility and benefits following State guidelines, is pro-active in patients' case coordination, and participates in due process proceedings; provides consultation to CCS Nurse Case Managers and to all other case management team members regarding CCS medical eligibility and program benefits; assists CCS Nurse Case Managers with medical case management and follow-up of complex cases.
  • Assists medical case management team in making appropriate referrals for those patients who are determined ineligible for CCS services; determines the projected medical expenditures for all children
  • Monitors the concurrent review done by hospital onsite nurse case managers
  • Evaluates unusual and expensive medical treatments, medical services and pharmaceuticals for which the program policy may not be clear or not covered
  • Communicates with the State CMS medical consultants and other experts in the field to determine benefit coverage and if denied, assist family with other funding sources
  • Reviews appeals and Notices of Action (NOAs) correspondence for medical eligibility and processes documents for fair hearings
  • Reviews local and statewide data to develop and help guide local CCS policy
  • Participates in interagency coordination and collaboration through outreach and training programs. Participates with the CCS team to provide training to health care professionals, pediatric service agencies and local schools
  • Ensures quality management through in-service training and Quality Assurance/ Quality Improvement (QA/QI) activities. Develops and implements QA/QI activities with regard to case finding and medical case management


Requirements

MUST BE A COUNTY OF LOS ANGELES EMPLOYEE WHO HOLDS THE PAYROLL TITLE OF
PHYSICIAN SPECIALIST


DESIRABLE QUALIFICATIONS

Board certified pediatrician or a board certified family practice physician with strong pediatric clinical experience

Interested employees are invited to submit a cover letter, their résumé, copies of their last two (2) performance evaluations, copies of their attendance record for the last 24 months, and any additional information the candidate wishes to have considered. All materials submitted will be evaluated. Only the most qualified employees will be contacted for an interview.

Submit documents via US mail or email to:

Jacklyn Jorge
County of Los Angeles
Department of Public Health
Children's Medical Services
California Children's Services
Medical Administration
9320 Telstar Avenue
El Monte, CA 91731

(626) 569-6190
JacJorge@ph.lacounty.gov


Closing Date/Time: