Remote Marketplace Medical Director

TieTalent; United States; Remote; USD 231,000 - 441,000; Full time

Job summary

A leading company is seeking a Remote Marketplace Medical Director to assist in directing medical management and quality improvement initiatives. This role requires an MD or DO with utilization management experience and offers a competitive salary range along with comprehensive benefits, including flexible work schedules.

Benefits

Health insurance

401K

Stock plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• MD or DO with utilization management experience required.
• Active medical practice is mandatory.
• Experience with diverse populations preferred.

Responsibilities

• Direct and coordinate medical management and quality improvement.
• Provide medical leadership for utilization management activities.
• Conduct rounds for high-risk patients and collaborate with care teams.

Skills

Utilization Management

Medical Leadership

Quality Improvement

Education

MD or DO

Coursework in health administration

Job description

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About
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 in directing and coordinating the medical management, quality improvement, and credentialing functions for the business unit. MST or PST hours preferred.

• Provides medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Performs medical review activities related to utilization review, quality assurance, and complex or controversial medical services, ensuring timely and quality decisions.
• Supports performance improvement initiatives for capitated providers.
• Helps establish goals and policies to improve quality and cost-effectiveness of care.
• Provides medical expertise in quality improvement and utilization management programs, complying with regulatory and accreditation standards.
• Assists in physician committee operations, including structure, processes, and membership.
• Conducts rounds to assess and coordinate care for high-risk patients, collaborating with care teams.
• Collaborates with clinical teams, providers, and consultants on complex cases and appeals.
• Participates in provider network development and market expansion.
• Supports physician education on clinical issues and policies.
• Identifies utilization trends and clinical quality improvement opportunities.
• Interfaces with providers to implement recommendations for improving utilization and quality.
• Reviews claims for complex or unusual services to determine medical necessity and payment appropriateness.
• Develops provider alliances through medical management programs.
• Represents the business unit on medical philosophy and policy issues locally and nationally.

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 advantageous. Experience with diverse populations preferred.

License/Certifications: Board certification in a recognized specialty, valid unrestricted state license as MD or DO.

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

Centene is an equal opportunity employer committed to diversity and inclusion. All qualified applicants considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.