Medical Director PRN

Centene Corp.; Indiana; Remote; USD 142,000 - 271,000; Part time

Job summary

Centene Corp seeks a Medical Director PRN to support the CMO in directing the physician component of utilization management for the health plan units. The position is remote in Indiana, part-time (~20 hours/week), with Thursdays and Fridays as the highest priority. Board-certified MD/DO with an active Indiana license and utilization management experience is required. Will lead reviews, appeals, and quality-improvement efforts.

Qualifications

• Requires Medical Doctor or Doctor of Osteopathy; board certified.
• Active Indiana medical license required; multiple state licenses preferred.
• Utilization management experience preferred.
• Experience in managed care settings is advantageous.

Responsibilities

• Provide medical leadership for utilization management and medical review activities, including utilization review, quality assurance, and review of complex or experimental services with consultants.
• Perform case reviews and appeals for all health plans.
• Assist CMO in planning and setting goals to improve quality and cost-effectiveness of care.
• Offer medical expertise for operating approved quality improvement and utilization management programs in line with regulatory and accreditation standards.
• Identify utilization review studies and monitor adverse utilization trends.
• Identify clinical quality improvement opportunities to reduce unwarranted practice variation.
• Review claims involving complex or unusual services to determine medical necessity and appropriate payment.

Skills

Utilization management experience

Medical leadership

Active practicing physician

Education

MD or DO

Board Certification (ABMS)

Job description

Medical Director PRN### Medical Director PRNApply: Remote-IN: Part time: Posted Today: 1670748**Position Purpose:** Assist the CMO to direct and coordinate the physician component of the utilization management functions for the health plan business units. **Key Details:** Must be Board Certified Physician with an active Indiana MD or DO state license. The ideal candidate will reside in Indiana and have utilization management experience. This role is roughly 20 hours per week with Thursdays/Fridays being the highest priority. * Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants* Performs case reviews and appeals for all health plans.* Assists CMO in planning, 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.* 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.* Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment**Education/Experience:*** Requires a Medical Doctor or Doctor of Osteopathy, board certified preferably in a primary care specialty (Internal Medicine, Med/Peds, Family Practice, Pediatrics or Emergency Medicine) or other specialty familiar with Medicare patients.* Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.* Experience treating or managing care for a culturally diverse population preferred. The candidate must be an actively practicing physician. More than 1 state license is preferred. **License/Certifications:*** Board Certification through American Board Medical Specialties.* Current Indiana state medical license without restrictions.Pay Range: $103.37 - $196.39 per hour **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, 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.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