Benefits, Waiver Analysis, and Rates Division (Medi-Cal)
Medical Consultants work in Sacramento. They develop and interpret medical policies and procedures relating to the scope of benefits under the Medi-Cal program. In addition they provide professional consultation and direction to the medical consultants of the Field Offices Services Branch of the Utilization Management Division.
Pharmacy Benefits Division (Medi-Cal)
Medical consultants work in Sacramento and provide a variety of consultative services related to development of pharmacy policy and quality improvement efforts. In addition, consultant(s) provide liaison with Medi-Cal fee-for-service and managed care medical and professional staffs.
Clinical Assurance and Administrative Support Division (Medi-Cal)
Medical Consultants work at Field Offices located throughout the state. They adjudicate Treatment Authorization Requests (TARs) by determining, on the basis of submitted documentation, whether the requested services are medically necessary. They also assist the Division’s Nurse Evaluators with medical issues related to TARs and educate providers about the TAR process.
Medi-Cal Managed Care Division
Medical Consultants develop and update medical policy for specific programs and services provided by contracted health plans. Coordinate the work and consult with Division professional and technical staff regarding policy to assure consistency of development and implementation. Coordinate or consult regarding quality improvement, plan monitoring activities, and serve as liaison to other Departments and Public Health.
Systems of Care Division [including: Children’s Medical Services (CMS) and Medi-Cal Case Management (MCM) Section]
Public Health Medical Officers working for the CMS provide medical expertise and consultation into the development of policies for the California Children's Services (CCS) and CHDP programs; provide consultation into the development of new health care programs for children and adolescents and provide consultation and technical assistance to county programs and enrolled providers.
The MCM Medical Consultant provides program direction and consultation to approximately 75-85 MCM nurses statewide. The nurse case managers coordinate and approve outpatient services for chronically and catastrophically ill Medi-Cal beneficiaries to prevent avertable hospital admissions.
Long Term Care Division (including: Home and Community Based Waivers)
Medical Consultants work in Sacramento and provide consultation on level of care determinations for beneficiaries who receive long-term care services at home in lieu of institutionalization. Provide medical expertise on new federal grant programs, social health maintenance organizations, long-term care insurance programs, and federal home and community-based waiver programs, including the effectiveness of services and benefits, and represent the division at state hearings.
Office of Clinical Preventive Medicine
Public Health Medical Officers assist executive and departmental staff in DHCS with issues related to clinical preventive services. The officers play a leadership role in assuring collaborative activities with DHCS and public health experts in the California Department of Public Health, other state agencies, health plans, and other entities that deliver health care.
Audits and Investigations
Working at seven Field Offices located throughout the state, Medical Consultants work closely with other professional audit staff to provide guidance for adjudication of Medi-Cal provider claims in our efforts to ensure program integrity and combat fraud. They also review Managed Care Plans for State contract compliance. Their work often involves direct interaction with providers at their offices, clinics, hospitals, etc. Travel is involved regularly, and though often local, may be state-wide.
Office of HIPAA Compliance
Medical Consultants function as senior clinical advisors to management and as lead clinicians over other HIPAA workgroup clinical members. They provide expert medical opinion and guidance on national coding standards as applicable to the Medi-Cal program. They evaluate and analyze the impact of adopting national coding standards on current and future Medi-Cal policies and services. The consultants serve as liaisons to various DHCS program areas and other stakeholders.
Physicians who work for the DHCS receive professional satisfaction from providing medical guidance and leadership in the vital programs listed above.
As a California state employee, DHCS physicians enjoy a complete range of state benefits including paid vacations and sick leave; medical, dental, and vision insurance; and eventual vesting in the California Public Employees Retirement System (CalPERS) and its defined benefit pension plan and retirement health benefits.
The process of becoming a career physician with DHCS is not difficult but, admittedly, is quite different than the process by which you obtained your current position as a practicing, academic, or administrative physician. The basic steps are outlined in this link from the State Personnel Board:
How to Apply for a State Job.
If you are intrigued by the possibility of a DHCS career and are anxious to employ your medical knowledge and experience within an exciting new opportunity, we strongly encourage you to take the civil service examinations for which you are qualified. There is no cost or obligation but, if you are successful on the exams, you establish your eligibility to be considered for specific positions as they become available.
