Medical Director - Illinois

RemoteWorker US; Hamel (IL); Remote; USD 221,000 - 421,000; Full time

Job summary

RemoteWorker US is seeking a Medical Director to lead medical management and quality improvement initiatives for their diverse member base. The role demands strong leadership in utilization management while ensuring high-quality care and support for clinical teams. Preference given to candidates with significant experience in managing care for diverse populations and proven medical expertise.

Benefits

Flexible work schedules

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Qualifications

• Active practice as a physician required.
• Experience with culturally diverse populations preferred.
• Coursework in Health Administration, Financing, and Management advantageous.

Responsibilities

• Provide leadership for utilization management and medical quality.
• Conduct medical reviews and ensure policy compliance.
• Coordinate care for high-risk patients collaboratively.

Skills

Utilization Management

Medical Quality Improvement

Collaboration

Clinical Expertise

Education

Medical Doctor (MD) or Doctor of Osteopathy (DO)

Job description

Join to apply for the Medical Director - Illinois role at RemoteWorker US

2 days ago Be among the first 25 applicants

Join to apply for the Medical Director - Illinois role at RemoteWorker US

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!

• 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 appropriates
• 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.
• Consult's on MCO clinical policy related to Substance Use Disorders and the cases of individual members for the MCM program on a routine basis.
• Performs other duties as assigned
• Complies with all policies and standards
  
  

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

For Illinois plan only: Must reside in Illinois. Must have a minimum of eight (8) years of experience in mental health, substance abuse, or children health services.

Pay Range: $221,300.00 - $420,500.00 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. Total compensation may also include additional forms of incentives.

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

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Staffing and Recruiting

Referrals increase your chances of interviewing at RemoteWorker US by 2x

Sign in to set job alerts for “Medical Director” roles.

Collinsville, IL $50,000.00-$400,000.00 1 day ago

Staunton, IL $50,000.00-$400,000.00 6 hours ago

Edwardsville, IL $50,000.00-$400,000.00 2 days ago

Edwardsville, IL $50,000.00-$400,000.00 5 days ago

Alton, IL $50,000.00-$400,000.00 2 days ago

Alton, IL $50,000.00-$400,000.00 4 days ago

Alton, IL $50,000.00-$400,000.00 5 days ago

Collinsville, IL $50,000.00-$400,000.00 2 days ago

Collinsville, IL $50,000.00-$400,000.00 5 days ago

Litchfield, IL $50,000.00-$400,000.00 5 days ago

Litchfield, IL $50,000.00-$400,000.00 2 days ago

Alton, IL $50,000.00-$400,000.00 7 hours ago

Litchfield, IL $50,000.00-$400,000.00 4 days ago

Alton, IL $50,000.00-$400,000.00 4 days ago

Edwardsville, IL $50,000.00-$400,000.00 4 days ago

O'Fallon, IL $50,000.00-$400,000.00 1 week ago

Fairview Heights, IL $50,000.00-$400,000.00 5 days ago

Alton, IL $50,000.00-$400,000.00 4 days ago

Collinsville, IL $50,000.00-$400,000.00 4 days ago

Collinsville, IL $50,000.00-$400,000.00 4 days ago

Benld, IL $221,300.00-$420,500.00 2 days ago

Gillespie, IL $221,300.00-$420,500.00 2 days ago

Assistant Medical Director - Emergency Medicine - HSHS St. Joseph's Hospital - Highland

Fairview Heights, IL $85,000.00-$88,000.00 2 weeks ago

St Louis, MO $50,000.00-$55,000.00 1 week ago

Staunton, IL $50,000.00-$400,000.00 6 hours ago

Alton, IL $50,000.00-$400,000.00 7 hours ago

Collinsville, IL $50,000.00-$400,000.00 7 hours ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.