Medical Director

Centene Corporation • Tallahassee, FL • 2h 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.

We're Hiring: Full time Medical Director for our Health Plan in Florida. This role is primarily working LTC cases.

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

Board Certified Physician

Must be licensed in Florida

Florida Resident

Internal Medicine or Family Medicine HIGHLY preferred

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 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.

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.

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

Pay Range: $236,500.00 - $449,300.00 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

Physical Therapist

UnitedHealth Group • Tallahassee, FL • 4h ago

Hospital & Medical

Requisition number: 2377211 Job category: Healthcare Delivery, Rehabilitation Services Explore opportunities with Suncrest OMNI, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and famili...

4h ago

Go to Apply

Medical Assistant

MTC • Quincy, FL • 1d ago

Hospital & Medical

Pay: $20.00/hr. Location: 6044 Greensboro Highway Quincy, Florida 32351 Work schedule: Full-time Benefit package includes: Medical, vision, and prescription drug benefits Dental benefits Life insurance Accidental death a...

1d ago

Go to Apply

Technology Consulting - Microsoft Dynamics 365 Supply Chain Solution Architect - Manager

EY • Tallahassee, FL • 2d ago

Hospital & Medical

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY...

2d ago

Go to Apply

Medical Technologist

HCA Healthcare • Tallahassee, FL • 3d ago

Hospital & Medical

HCA Florida Capital Hospital 2626 Capital Medical Blvd Tallahassee, FL 32308 Do you want to join an organization that invests in you as a Medical Technologist? At HCA Florida Capital Hospital, you come first. HCA Healthc...

3d ago

Go to Apply

Technical Product Manager - Manager - Consulting - Location OPEN

EY • Tallahassee, FL • 3d ago

Hospital & Medical

3d ago

Go to Apply

Actuary - Primary Care Organization

CenterWell • Tallahassee, FL • 5d ago

Hospital & Medical

Become a part of our caring community The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Esta...

5d ago

Go to Apply

Dental Hygienist

Justice, Bureau of Prisons/Federal Prison System • Tallahassee, FL • 5d ago

Hospital & Medical

Summary Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities. Responsibilities Responsible planning and direct...

5d ago

Go to Apply

Staff Clinical Consultant

Oracle • Tallahassee, FL • 5d ago

Hospital & Medical

Job Description Responsible for driving the client through the design of clinical and business processes, solution and technology workflow, and successful adoption that will lead to achieved value. Manage ongoing relatio...

5d ago

Go to Apply

Technical Project Manager

GovCIO • Tallahassee, FL • 6d ago

Hospital & Medical

United States Suitability/Public Trust Hybrid schedule Information Technology Overview GovCIO is currently hiring for a Technical Project Manager to serve as a Team Lead for projects, handling all coordination and tasks...

6d ago

Go to Apply

Pharmacy Technician Supervisor Central Fulfillment Center

Intermountain Health • Tallahassee, FL • 6d ago

Hospital & Medical

Job Description: Job Specifics: Schedule: Full Time Shift Details: Generally, Monday to Friday 8-hour shifts with flexibility covering needs as determined by patient care and staffing Location: Supply Chain Center, Midva...

6d ago

Go to Apply

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