Part-time Pediatric / Family Medicine Medical Director - Florida

Sunshine Health; Orlando (FL); Remote; USD 231,000 - 441,000; Part time

Job summary

An established industry player is seeking a dedicated Pediatric/Family Medicine Medical Director to enhance the quality of care for its members. This part-time role offers the flexibility of remote work while requiring Florida residency. You will lead medical management initiatives, ensuring compliance with regulations and driving quality improvement across diverse populations. With a competitive salary and comprehensive benefits, this opportunity allows you to make a significant impact in a dynamic healthcare environment. If you are a board-certified physician passionate about improving healthcare delivery, this role is perfect for you.

Benefits

Health Insurance

401K

Stock Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Options

Qualifications

• MD or DO with utilization management experience preferred.
• Active medical practice required with knowledge of accreditation standards.

Responsibilities

• Provide medical leadership for utilization management and quality improvement.
• Conduct rounds for high-risk patients and collaborate with care teams.
• Support performance improvement initiatives for capitated providers.

Skills

Utilization Management

Quality Improvement

Medical Leadership

Clinical Expertise

Collaboration with Care Teams

Education

MD or DO

Coursework in Health Administration

Job description

Part-time Pediatric / Family Medicine Medical Director - Florida

Join to apply for the Part-time Pediatric / Family Medicine Medical Director - Florida role at Sunshine Health.

Get AI-powered advice on this job and more exclusive features.

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 workplace flexibility.

Position Purpose

Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit. This role is remote but requires Florida residency.

Responsibilities

1. Provide medical leadership for utilization management, cost containment, and quality improvement activities.
2. Perform medical reviews related to utilization, quality assurance, and complex or controversial medical services, ensuring timely decisions.
3. Support performance improvement initiatives for capitated providers.
4. Assist in planning and establishing goals to improve quality and cost-effectiveness of care.
5. Provide medical expertise for quality improvement and utilization management programs, complying with regulations and standards.
6. Support physician committees, including structure, processes, and membership.
7. Conduct rounds for high-risk patients, collaborating with care teams.
8. Work with clinical teams, providers, and consultants on complex cases and appeals.
9. Participate in provider network development and market expansion.
10. Assist in physician education on clinical issues and policies.
11. Identify utilization trends, adverse patterns, and clinical quality improvement opportunities.
12. Facilitate implementation of recommendations to providers to enhance utilization and quality.
13. Review claims involving complex or new services for medical necessity and payment accuracy.
14. Develop alliances with providers through medical management programs.
15. Represent the business unit at public and state committees as needed.
16. May work weekends and holidays to support operations.

Education/Experience

MD or DO, with 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 (preferably Pediatrics or Family Medicine). Current Florida MD or DO license without restrictions or sanctions.

Additional Information

Pay Range: $231,900 - $440,500 annually. Benefits include health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work options. Compensation adjusted based on experience and qualifications.

Centene is committed to diversity and equal opportunity employment. Qualified applicants with arrest or conviction records will be considered per applicable laws.