Behavioral Health Medical Director

Centene Management Company LLC; California; Hybrid; USD 237,000 - 449,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote/hybrid

Job summary

Centene is seeking a Board Certified Psychiatrist to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role requires California or Oregon licensure and board certification; Pacific Time Zone residence is highly preferred.

You will provide medical leadership for utilization management, review complex cases, support performance improvement initiatives, and collaborate with clinical teams, providers, and committees

Qualifications

• MD or DO degree; Utilization Management experience and knowledge of quality accreditation standards preferred.

Responsibilities

• Provides medical leadership of utilization management, cost containment, and medical quality improvement activities.
• Performs medical reviews for utilization review and quality assurance to ensure timely decisions.
• Assists in planning goals and policies to improve quality and cost-effectiveness of care for members.
• Reviews complex or new services to determine medical necessity and appropriate payment.
• Develops alliances with providers and participates in provider network development and new market expansion.

Education

Medical Doctor or Doctor of Osteopathy

Job description

Position Purpose

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

Key Details

Must be a Board Certified Psychiatrist and licensed in either California or Oregon. Highly preferred the candidate lives in the Pacific Time Zone.

Responsibilities

• 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. Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs. For Behavioral Health only - Board certification by the American Board of Psychiatry and Neurology. Current state medical license without restrictions.

Pay Range

$236,500.00 - $449,300.00 per year

Company Overview & Benefits

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Also, we’re here to help support you on your candidate journey. Thanks for your interest in Centene and its subsidiary companies. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well. 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.

Equal Opportunity Statement

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.

Contact

Should you need an accommodation, please email [e-mail].