Remote Medical Director, Appeals & Quality Programs

Centene Corporation; United States; Remote; USD 236,500 - 449,300; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

A diversified healthcare organization is seeking a clinical professional to lead medical management services. Responsibilities include overseeing utilization review, coordinating quality improvement initiatives, and collaborating with various clinical teams to ensure optimal patient outcomes. The ideal candidate must be a licensed Medical Doctor or Doctor of Osteopathy, preferably with expertise in managing diverse populations. This role offers competitive pay, a comprehensive benefits package, and flexible work arrangements.

Qualifications

• Active Board certification in a medical specialty required.
• Experience treating diverse populations preferred.
• Utilization management experience is an advantage.

Responsibilities

• Direct and coordinate medical management functions.
• Perform medical reviews for utilization and quality assurance.
• Collaborate with care management teams for high-risk patients.
• Assist in education and training of physicians regarding clinical issues.

Skills

Medical leadership of utilization management

Collaboration with clinical teams

Conducting medical reviews

Performance improvement initiatives

Understanding quality accreditation standards

Education

Medical Doctor or Doctor of Osteopathy

Coursework in Health Administration

Job description

A diversified healthcare organization is seeking a clinical professional to lead medical management services. Responsibilities include overseeing utilization review, coordinating quality improvement initiatives, and collaborating with various clinical teams to ensure optimal patient outcomes. The ideal candidate must be a licensed Medical Doctor or Doctor of Osteopathy, preferably with expertise in managing diverse populations. This role offers competitive pay, a comprehensive benefits package, and flexible work arrangements.