Medical Director

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San Francisco Health Plan is committed to providing high-quality care for low-income San Franciscans and supporting the provider safety net. We leverage our resources to support the triple aim: improved population health, improved quality of care, and improved affordability. The individual in this position is the Plan’s primary UM physician conducting concurrent and prior authorization case reviews, is the health plan physician lead on the Health Homes program and the San Francisco Safety Net Pain workgroup, and provides physician consultative expertise to the health services department: clinical operations (UM: inpatient and outpatient, and discharge transition planning), health improvement (HEDIS, practice improvement, disease management, member grievance reviews, IT systems that support department functions, and member incentives) and pharmacy (including PGY 1 pharmacy residency and medication therapy management program).

The Medical Director also plays an important role with key health plan initiatives, such as the implementation of a care management system designed to improve coordination of care and achieve better clinical outcomes, creating clinical criteria, and evaluating UM strategies to improve efficiency.

Salary range: $241,950 – $288,750

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

• Provides primary leadership of SFHP’s program which serves at risk and medically complex members as defined by internal risk stratification as well as health plan mandate (e.g. Health Homes)..
• Provides SFHP clinical leadership of the San Francisco Safety Net Pain Management workgroup.

• Provides clinical guidance on medical necessity and transfer decisions to support UM staff. Responsibilities include contacting attending and ED physicians to discuss patients when appropriate.
• Shares responsibility for utilization management and pharmacy decisions: determining medical necessity based on established criteria, interpreting benefits and limitations, and consulting with providers as appropriate.
• Actively participates in Utilization Management Committee.
• Calls physicians at his/her discretion to discuss management of members related to pharmacy and UM authorizations, inpatient care, and/or high-dose pain management focusing on evidence, best practices, and medical necessity.

• Investigates and resolves potential quality incidents and determines their appropriateness for review by the Physician Advisory Committee.
• Reviews appeals and provides second opinions regarding medical necessity
• Reviews clinical grievances and is an active participant in Grievance Review Committee

• Pharmacy
  • Participates in formulary criteria development
• Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use of services, clinical practice guidelines, and treatment guidelines

• Provides clinical support for program development of disease management and practice improvement.
• May serve on Quality Improvement Committee, Pharmacy and Therapeutics Committee, or the Practice Improvement Program Advisory Group.
• Represents SFHP with our external community partners, including giving presentations related to SFHP priorities as needed
• Leads special projects and assignments as requested by the Sr. Medical Director and/or Chief Medical Officer.
• Provides clinical guidance related to systems implementations (such as care management IT integration systems)

• MD/DO degree from an accredited program, with active, unrestricted California medical license. Board certified required.
• A current CA license to practice without restriction.
• 5+ years of clinical…