Medical Director at Centene

**Who this is for** This role is for a board-certified physician looking to move into a high-level leadership position within a large healthcare organization. I

Work type: remote

Location: Remote-LA

Salary: $225,700 – $428,900/yr

Type: Full-time

Summary

**Who this is for** This role is for a board-certified physician looking to move into a high-level leadership position within a large healthcare organization. It suits an MD or DO who wants to focus on medical management, quality assurance, and community health strategy rather than direct patient care. **Key highlights** You will serve as a key partner to the Chief Medical Officer, overseeing utilization management, provider network development, and clinical quality improvement programs. This position allows you to influence healthcare policy and operational standards for a national Medicaid and Medicare provider. **You might be a good fit if you...** - Are a Board Certified Physician with active licensure in Louisiana. - Have a strong background in medical management, quality accreditation, or health administration. - Are comfortable navigating complex medical necessity reviews and controversial clinical cases. - Enjoy collaborating with interdisciplinary teams to optimize provider practice patterns and clinical outcomes.

Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

We’re Hiring: Full time Medical Director

Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace.

Looking for a compelling opportunity to move beyond patient encounters and drive meaningful change in the community?

Qualifications for this role include:

• MD or DO without restrictions


• Must be licensed in Louisiana


• Board Certified Physician

• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.


• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.


• Supports effective implementation of performance improvement initiatives for capitated providers.


• Assists Chief Medical Officer in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.


• Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.


• Assists the Chief Medical Officer in the functioning of the physician committees including committee structure, processes, and membership.


• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.


• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.


• Participates in provider network development and new market expansion as appropriate.


• Assists in the development and implementation of physician education with respect to clinical issues and policies.


• Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.


• Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.


• Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.


• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.


• Develops alliances with the provider community through the development and implementation of the medical management programs.


• As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.


• Represents the business unit at appropriate state committees and other ad hoc committees.


• May be required to work weekends and holidays in support of business operations, as needed.

• Medical Doctor or Doctor of Osteopathy.


• Utilization Management experience and knowledge of quality accreditation standards preferred.


• Actively practices medicine or has been an actively practicing physician within the last 5 years.


• Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.


• Experience treating or managing care for a culturally diverse population preferred.

• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.


• Current Louisiana state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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