MEDICAL CONSULTANT I, DEPARTMENT OF HEALTH SERVICES

Medical Consultant I

The Department of Health Care Services (DHCS) is the backbone of California's health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today!

About this Role:

Under direction of the Medical Consultant II (Supervisor), the Medical Consultant (MC) I reviews and acts on Treatment Authorization Requests (TARs) and medical records received from providers for services to beneficiaries of the California Medical Assistance Program (Medi-Cal). The MC I provides consultation to the field office and headquarters nursing staff when adjudication decisions of TARs require denial or modification, and to nursing staff conducting post-claims oversight case reviews at assigned hospitals to ensure hospital compliance with Medi-Cal policy. The incumbent may be asked to review Appeals, Disputes and Litigation and may be required to represent the Department at Fair Hearings, Appeal Meetings, and Administrative Hearings. The incumbent may be asked to appear before peer groups, other provider groups, and community organizations to advise them on the medical aspects of the Program. Additionally, the MC I may be required to work on special projects involving medical chart reviews and assist in the Clinical Assurance Division's (CAD's) quality assurance efforts.

Travel statewide, including overnight, of up to 5% of the time, by airplane, train, automobile, and other transportation methods to attend Medical Consultant trainings and meetings may be required. Travel related duties may take up to a week at a time and several weeks per month and are dependent upon workload and operational need.

New to state candidates will be hired into the minimum salary of the classification or minimum of the alternate salary range when applicable. Placement to alternate range may be based on education or experience identified in your state application.

This position is designated under the Conflict of Interest Code. The position is responsible for making or participating in the making of governmental decisions that may potentially have a material effect on personal financial interests. The appointee is required to complete Form 700 within 30 days of appointment and once per year. Failure to comply with the Conflict of Interest Code requirements may void the appointment. This advertisement is posted as until filled. Applications will be reviewed monthly. The cutoff dates will be: September 23, 2026, October 7, 2026, October 21, 2026, November 4, 2026, November 18, 2026, December 2, 2026, December 16, 2026, December 30, 2026, January 13, 2027, January 27, 2027, February 10, 2027, and February 24, 2027.

You will find additional information about the job in the Duty Statement.