Medical Director

Centene Corporation; New York (NY); Vor Ort; USD 215.000 - 409.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote/hybrid

Zusammenfassung

Centene Corporation in New York seeks an experienced physician to oversee medical management, quality improvement, and credentialing for the unit. You will lead utilization management, drive cost containment, and advance clinical quality initiatives across networks and committees.

The role requires board certification, an active NY license, and the ability to work with diverse care teams to optimize outcomes for members. Location flexibility within NY preferred.

Qualifikationen

• Board-certified physician with NY license required.
• Utilization management and quality accreditation knowledge preferred.
• Experience leading medical teams and committees.

Aufgaben

• Leads utilization management and medical quality improvement activities.
• Performs medical reviews for utilization and quality assurance.
• Supports performance improvement initiatives for capitated providers.
• Assists in planning goals and policies to improve cost-effectiveness.
• Represents medical philosophy and policies before committees as needed.
• Coordinates care for high-risk patients with care management teams.
• Collaborates with providers for reviewing complex cases and appeals.
• Develops alliances with the provider network and new markets.

Kenntnisse

Healthcare leadership

Quality improvement

Utilization management

Cross-functional collaboration

Ausbildung

MD/DO

Board certification (ABMS/AOA)

Jobbeschreibung

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 Board Certified Physician with an active New York MD or DO state license. The ideal candidate will reside in NY or have working ties to the state (previous resident, education, residency, fellowship, etc.)

• 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 Psychiatry specialty Is required.) Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Pay Range: $215,000.00 - $408,500.00 per year

About Centene

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.

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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