National Medical Director: Remote Quality & Utilization

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

Ventajas ofrecidas por este puesto de trabajo

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible schedules

Descripción de la vacante

Centene Management Company LLC is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

You will oversee utilization management, cost containment, and medical quality programs, providing expert medical review for complex or controversial services and supporting performance improvements across capitated networks.

Formación

• Medical Doctor or Doctor of Osteopathy with an active state license.
• Utilization Management experience and knowledge of accreditation standards.
• Board certification in a medical specialty recognized by ABMS or AOA; unrestricted MD/DO license.

Responsabilidades

• Direct and coordinate medical management, quality improvement and credentialing for the business unit.
• Lead utilization review, QA and medical review to ensure timely, quality decisions.
• Support performance improvement initiatives for capitated providers and coordinate care for high-risk patients.
• Represent the business unit on state or national committees and internal physician education.
• Collaborate with clinical teams, network providers and appeals for complex case reviews.

Conocimientos

Utilization Mgmt

Quality improvement

Medical leadership

Team collaboration

Provider relations

Educación

MD/DO degree

Health Admin coursework

Descripción del empleo

Centene Management Company LLC is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

You will oversee utilization management, cost containment, and medical quality programs, providing expert medical review for complex or controversial services and supporting performance improvements across capitated networks.