Remote Behavioral Medical Director

Centene Corporation; Georgia (VT); Remote; USD 231,000 - 441,000; Full time

Job summary

A leading national organization seeks a Remote Behavioral Medical Director to provide medical leadership and improve quality and cost-effectiveness of care for its members. This role involves directing medical management, conducting reviews, and collaborating with various teams to optimize patient outcomes. The position offers competitive pay and comprehensive benefits, promoting flexibility and diversity in the workplace.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Actively practices medicine.
• Utilization Management experience preferred.
• Experience in caring for a diverse population preferred.

Responsibilities

• Direct and coordinate medical management and quality improvement.
• Provide medical leadership for utilization management activities.
• Collaborate with clinical teams and network providers.

Skills

Utilization Management

Medical Leadership

Quality Improvement

Education

Medical Doctor

Doctor of Osteopathy

Job description

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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.

1. Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
2. Perform medical review activities related to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision-making.
3. Support effective implementation of performance improvement initiatives for capitated providers.
4. Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and services for members.
5. Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
6. Assist the Chief Medical Director in the functioning of physician committees, including structure, processes, and membership.
7. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
8. Collaborate effectively with clinical teams, network providers, appeals teams, and consultants for reviewing complex cases and medical necessity appeals.
9. Participate in provider network development and new market expansion as appropriate.
10. Assist in developing and implementing physician education regarding clinical issues and policies.
11. Identify utilization review studies and evaluate adverse trends in utilization, provider practice patterns, and benefit/payment components.
12. Identify clinical quality improvement studies to reduce unwarranted variation in practice and improve quality and cost of care.
13. Interface with physicians and providers to facilitate implementation of recommendations that improve utilization and healthcare quality.
14. Review claims involving complex, controversial, or new services to determine medical necessity and appropriate payment.
15. Develop alliances with the provider community through medical management programs.
16. Represent the business unit before various publics on medical philosophy, policies, and related issues as needed.
17. Participate in state and ad hoc committees as a representative of the business unit.
18. May be required to work weekends and holidays to support operations.

Education/Experience

Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of accreditation standards preferred. Actively practices medicine. Coursework in Health Administration, Health Financing, Insurance, or Personnel Management is advantageous. Experience in caring for a diverse population is preferred.

License/Certifications

Board certification by the American Board of Psychiatry and Neurology. Current unrestricted state medical license as MD or DO.

Compensation and Benefits

Pay Range: $231,900.00 - $440,500.00 per year. Offers comprehensive benefits, including health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, and flexible work arrangements. Compensation is adjusted based on skills, experience, and other factors.

Equal Opportunity Employment

Centene is committed to diversity and equal opportunity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.