Medical Director, Health Plan — Quality & Utilization Leader

Centene Management Company LLC; New Hampshire; Híbrido; USD 215.000 - 409.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Descripción de la vacante

Centene Management Company LLC in New Hampshire invites a full-time Medical Director to lead medical management, quality improvement, and credentialing for our health plan. You will guide utilization management, reviews, and performance-improvement efforts, coordinating with care teams and providers to optimize outcomes and cost effectiveness.

The role requires MD/DO, board certification, NH licensure, and recent practice; utilization management experience is highly valued.

Formación

• MD or DO without restrictions.
• Board Certified Physician.
• Licensed in New Hampshire.
• Actively practices medicine or has been actively practicing within the last 5 years.
• Utilization Management experience preferred.

Responsabilidades

• Provide medical leadership for utilization management, cost containment and medical quality improvement.
• Perform medical review activities related to utilization review, quality assurance and complex or novel services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care.
• Oversee quality improvement and utilization management programs per regulatory standards.
• Coordinate physician committees and round to assess high-risk patients.
• Collaborate with clinical teams, network providers, appeals team and consultants on complex cases.
• Participate in provider network development and market expansion.
• Develop physician education on clinical issues and policies.
• Identify utilization review studies and monitor adverse trends in care and payment components.

Conocimientos

Medical leadership

Utilization management

Quality improvement

Clinical review

Provider collaboration

Educación

MD/DO

Board Certified

Descripción del empleo

Centene Management Company LLC in New Hampshire invites a full-time Medical Director to lead medical management, quality improvement, and credentialing for our health plan. You will guide utilization management, reviews, and performance-improvement efforts, coordinating with care teams and providers to optimize outcomes and cost effectiveness.

The role requires MD/DO, board certification, NH licensure, and recent practice; utilization management experience is highly valued.