Medical Director - Illinois

Meridian Illinois; Dieterich (IL); Remote; USD 221,000 - 421,000; Full time

Job summary

A leading healthcare organization is seeking a Clinical Professional to join their Medical Management team. This remote position involves directing medical management, ensuring quality improvement, and providing medical expertise. Candidates must be a Medical Doctor or Doctor of Osteopathy with relevant experience. The role offers competitive compensation and benefits, including health insurance and flexible work arrangements.

Benefits

Health Insurance

401K

Stock Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Active medical practice required.
• Utilization Management experience preferred.

Responsibilities

• Provide medical leadership for utilization management and quality improvement.
• Conduct regular rounds for high-risk patients.
• Assist in developing physician education on clinical issues.

Skills

Utilization Management

Quality Improvement

Medical Leadership

Education

Medical Doctor

Doctor of Osteopathy

Job description

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. This position is REMOTE!

Responsibilities:

1. Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
2. Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental medical services, ensuring timely and quality decision-making.
3. Support effective implementation of performance improvement initiatives for capitated providers.
4. Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
5. Provide medical expertise in the operation of quality improvement and utilization management programs, complying with regulatory, state, corporate, and accreditation standards.
6. Assist in the functioning of physician committees, including structure, processes, and membership.
7. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams.
8. Collaborate with clinical teams, network providers, appeals teams, and consultants for complex case reviews and appeals.
9. Participate in provider network development and market expansion.
10. Assist in developing and implementing physician education on clinical issues and policies.
11. Identify utilization review studies and evaluate trends and provider practices.
12. Identify clinical quality improvement opportunities to reduce unwarranted variation and improve care quality and cost.
13. Interface with providers to facilitate implementation of recommendations.
14. Review claims involving complex or unusual services to determine medical necessity and payment.
15. Develop alliances with the provider community through management programs.
16. Represent the business unit at public forums and committees as needed.
17. Support weekend and holiday work as required.
18. Consult on clinical policies related to Substance Use Disorders and member cases for the MCM program.
19. Perform other duties as assigned and ensure compliance with policies and standards.

Education/Experience:

Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of accreditation standards preferred. Active medical practice required. Coursework in health administration, financing, insurance, or personnel management is advantageous. Experience with diverse populations preferred.

Licenses/Certifications:

Board certification in a recognized medical specialty. Current unrestricted Illinois MD or DO license. For Illinois plan only: residence in Illinois and at least 8 years of experience in mental health, substance abuse, or children’s health services.

Compensation and Benefits:

Pay Range: $221,300 - $420,500 annually. Benefits include competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements. Actual pay will depend on skills, experience, and education.

Equal Opportunity Statement:

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.