Remote Behavioral Medical Director

Centene Corporation; New York (NY); Remote; USD 231,000 - 441,000; Full time

Job summary

A leading healthcare organization seeks a Remote Behavioral Medical Director to oversee medical management and quality improvement initiatives. The role involves providing medical leadership, conducting reviews, and collaborating with clinical teams to enhance care quality for millions of members.

Benefits

Health Insurance

401K

Stock Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Options

Qualifications

• Active medical practice required.
• Experience with diverse populations preferred.

Responsibilities

• Direct and coordinate medical management and quality improvement functions.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams for case reviews and appeals.

Skills

Utilization Management

Quality Improvement

Medical Leadership

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.

• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities related to utilization review, quality assurance, and complex or controversial medical services, ensuring timely, quality decisions.
• Support performance improvement initiatives for capitated providers.
• Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care.
• Provide medical expertise in quality improvement and utilization management programs, adhering to regulatory and accreditation standards.
• Support the functioning of physician committees, including structure, processes, and membership.
• Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care management teams.
• Collaborate with clinical teams, providers, and consultants for case reviews and appeals.
• Participate in provider network development and market expansion.
• Develop and implement physician education on clinical issues and policies.
• Identify utilization review studies and evaluate trends in service utilization and provider practices.
• Identify clinical quality improvement opportunities to enhance care quality and reduce unwarranted variation.
• Facilitate implementation of recommendations to providers to improve utilization and quality.
• Review claims involving complex or unusual services to determine medical necessity and payment appropriateness.
• Develop alliances with providers through medical management programs.
• Represent the business unit at public forums and committees as needed.
• May require weekend and holiday work to support operations.

Education/Experience

Medical Doctor or Doctor of Osteopathy with utilization management experience and knowledge of accreditation standards preferred. Active medical practice required. Coursework in health administration, financing, insurance, or personnel management advantageous. Experience with diverse populations preferred.

License/Certifications

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

Pay Range: $231,900.00 - $440,500.00 per year.

Centene offers comprehensive benefits including competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work options. Actual pay depends on skills, experience, and other factors. Total compensation may include incentives.

Centene is an equal opportunity employer committed to diversity. 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. Applicants with arrest or conviction records will be considered per applicable laws.

Additional Details

• Seniority level: Not Applicable
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals, Healthcare, Insurance