Public / Community Health Physician

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose

Reviews requests for prior authorization and appeals for approval or denial of claims payment based on medical necessity. Oversees medical coordination required for effective utilization and quality management of the health plan network. Supports the clinical activities of PCHP Utilization Management, Quality Management, Clinical Policy, Technology Assessment, Credentialing, Population Health and Fraud, Waste and Abuse Functions to assure comprehensive, high quality health care to plan members in accordance with managed care and PCHP policies. Monitors clinical care needed to produce optimal health outcomes and cost-effective care.

Minimum Specifications

Education

Must have successfully completed an Accreditation Council for Graduate Medical Education (ACGME) or American Medical Association (AMA) approved residency in an appropriate specialty to the PCHP population.

Experience

• At least five years of clinical practice experience in a specialty relevant to the care of PCHP members. OB / GYN experience preferred.
• At least three years of experience in the care of populations relevant to the PCHP population or managed care.
• Experience in the development of medical policies, procedures and programs is preferred.
• Qualifications to perform clinical oversight for the services provided by the health plan to include but not limited to education, training or professional experience in medical or clinical practice preferred.
• Past participation in a managed care UM committee preferred.

Equivalent Education and / or Experience

Certification / Registration / Licensure

Required Tests for Placement

Skills or Special Abilities

Responsibilities

Job Accountabilities

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.