Part-Time Medical Director, Utilization Management (Remote)

Centene Corporation; Indiana; On-site; USD 142,000 - 271,000; Part time

Job summary

Centene Corporation is seeking a Board Certified physician to assist the Chief Medical Officer in directing the physician component of utilization management for the health plan business units in Indiana. The role is roughly 20 hours per week, with Thursdays and Fridays as the highest priority, and requires an active Indiana license.

You will provide medical leadership for utilization management activities, perform case reviews, and help plan goals to improve quality and cost-effectiveness of

Qualifications

• Requires board-certified MD/DO with primary care or related specialty.
• Experience in managed care is preferred.
• Active Indiana medical license and current practice status required.

Responsibilities

• Provide medical leadership for utilization management and medical review.
• Perform case reviews and appeals for health plans.
• Assist CMO in planning and policy development for quality and cost-effectiveness.
• Ensure compliance with regulatory and accreditation requirements in UM programs.
• Identify and evaluate trends in utilization and clinical practice patterns.
• Review claims involving complex or new services to determine medical necessity and payment.

Skills

Utilization management

Medical leadership

Case reviews

Quality improvement

Regulatory compliance

Education

MD or DO board certified

Managed care experience

Diverse populations experience

Job description

Centene Corporation is seeking a Board Certified physician to assist the Chief Medical Officer in directing the physician component of utilization management for the health plan business units in Indiana. The role is roughly 20 hours per week, with Thursdays and Fridays as the highest priority, and requires an active Indiana license.

You will provide medical leadership for utilization management activities, perform case reviews, and help plan goals to improve quality and cost-effectiveness of