Remote Medical Director

Centene Corporation • Jefferson City, MO • 1d ago

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.

Education/Experience:

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.

License/Certifications:

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.

Pay Range: $231,900.00 - $440,500.00 per year

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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Similar Jobs

Medical Director - Ophthalmology

Parexel • Jefferson City, MO • 1d ago

Hospital & Medical

Parexel is in the business of improving the world's health. We do this by providing a suite of biopharmaceutical services that help clients across the globe transform scientific discoveries into new treatments. From clin...

1d ago

Go to Apply

Senior Medical Writer - FSP

Parexel • Jefferson City, MO • 1d ago

Hospital & Medical

Parexel is looking for a Senior Medical Writer located anywhere in the United States or Canada . Early Development/Translational Medical Writing experience required. Job Purpose: The Senior Medical Writer is responsible...

1d ago

Go to Apply

Federal Senior Domain Integration Architect - Oracle Health

Oracle • Jefferson City, MO • 1d ago

Hospital & Medical

Job Description As an Integration Architect, you will be accountable for leading integrated client engagements. As a member of this team, you will manage complex client relationships with a high degree of variability, an...

1d ago

Go to Apply

Senior Clinical Pharmacist - Pipeline

Humana • Jefferson City, MO • 3d ago

Hospital & Medical

Become a part of our caring community and help us put health first Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to contribute to a hi...

3d ago

Go to Apply

Home Health Medical Social Worker (MSW or LCSW)

Phoenix Home Care and Hospice • Jefferson City, MO • 3d ago

Hospital & Medical

Home Health Medical Social Worker Full Time or PRN, Days Jefferson City, MO and surrounding areas Our Home Health Social Workers are dedicated to offering emotional and social support to individuals and their families ri...

3d ago

Go to Apply

Medicaid State Technology Lead

Humana • Jefferson City, MO • 4d ago

Hospital & Medical

Become a part of our caring community and help us put health first The State Technology Lead understands departmental and IT organizational strategy and operating objectives, including their linkages to related areas. Th...

4d ago

Go to Apply

Registered Nurse

Elara Caring • Jefferson City, MO • 4d ago

Hospital & Medical

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join ou...

4d ago

Go to Apply

Medical Director - OneHome

Humana • Jefferson City, MO • 5d ago

Hospital & Medical

Become a part of our caring community and help us put health first The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver...

5d ago

Go to Apply

Per Diem Intake Coordinator, Home Health

CenterWell • Jefferson City, MO • 5d ago

Hospital & Medical

Become a part of our caring community and help us put health first Shift/availability details: Per diem: scheduled up to 19 hours a week. Availability: all 7 days of the week between the hours of 7am-7pm EST. Available t...

5d ago

Go to Apply

Public Health Program Coordinator

CAI • Jefferson City, MO • 5d ago

Hospital & Medical

Public Health Program Coordinator Req number: R6632 Employment @type: Full time Worksite flexibility: Remote Who we are CAI is a global technology services firm with over 8,500 associates worldwide and a yearly revenue o...

5d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.