Remote Behavioral Medical Director - Lead Quality

Myana; Missouri; Hybrid; USD 236,500 - 449,300; Full time

Benefits offered by this job

Flexible work arrangements

Comprehensive benefits

Job summary

Centene is seeking a Medical Doctor or Doctor of Osteopathy to lead clinical management on our Medical Management/Health Services team in Missouri. The role involves medical leadership for utilization management, quality improvement, and cost containment across complex cases.

The physician will perform reviews, support performance improvement initiatives, and collaborate with provider networks, committees, and care management to optimize outcomes for members.

Qualifications

• MD or DO; utilization management experience and knowledge of quality accreditation standards preferred.
• Active medical practice.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Responsibilities

• Provides medical leadership of utilization management, cost containment, and medical quality improvement activities.
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex or experimental services.
• Supports performance improvement initiatives for capitated providers.
• Assists in planning and establishing goals and policies to improve quality and cost-effectiveness of care for members.
• Provides medical expertise in the operation of quality improvement and utilization management programs.
• Assists in physician committee functioning, structure, processes, and membership.
• Regular rounds to assess and coordinate care for high-risk patients with care management teams.

Education

MD or DO

Health Administration coursework

Experience caring for diverse population

Job description

Centene is seeking a Medical Doctor or Doctor of Osteopathy to lead clinical management on our Medical Management/Health Services team in Missouri. The role involves medical leadership for utilization management, quality improvement, and cost containment across complex cases.

The physician will perform reviews, support performance improvement initiatives, and collaborate with provider networks, committees, and care management to optimize outcomes for members.