Remote Medical Director at Centene

**Who this is for** This position is designed for an experienced Medical Doctor (MD) or Doctor of Osteopathy (DO) looking to provide clinical leadership within

Work type: remote

Location: Remote-MO

Salary: $236,500 – $449,300/yr

Type: Full-time

Summary

**Who this is for** This position is designed for an experienced Medical Doctor (MD) or Doctor of Osteopathy (DO) looking to provide clinical leadership within a large-scale managed care organization. **Key highlights** As a Medical Director, you will oversee utilization management, cost containment, and quality improvement activities while collaborating with multidisciplinary teams to optimize patient outcomes and regulatory compliance. **You might be a good fit if you...** - Hold an active, unrestricted MD or DO state license and board certification. - Have a background in utilization management, quality assurance, or health administration. - Are comfortable reviewing complex medical cases and identifying adverse utilization trends. - Have experience collaborating with clinical teams and provider networks in a diverse healthcare environment.

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.
 

Position Purpose:
Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

• 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 Director 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 Director 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.


• 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.

• Active 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.


• Certification in Internal or Family Medicine, preferred


• Current 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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