Remote Medical Director, Appeals & Utilization Leadership

Centene; United States; Hybride; USD 237 000 - 449 000; Plein temps

Avantages offerts par ce poste

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off & holidays

Flexible work schedules

Résumé du poste

Centene is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. You will provide medical leadership for utilization management, cost containment, and care quality initiatives to support members.

You will review complex cases for medical necessity and cooperate with care teams to optimize outcomes. You will help implement performance improvement programs, develop physician education, and

Qualifications

• MD or DO with board certification.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Actively practices medicine.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Responsabilités

• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical reviews for utilization review and quality assurance to ensure timely, quality decisions.
• Assist Chief Medical Director in planning goals and policies to improve quality and cost-effectiveness of care and service for members.
• Review in-depth case reviews to determine medical necessity and appropriate payment.
• Develop alliances with the provider community through medical management programs.
• Represent the business unit before state committees and ad hoc groups as needed.
• Collaborate with clinical teams, network providers, and care management for high-risk patient coordination.
• Assist in physician education regarding clinical issues and policies.

Connaissances

Medical leadership

Utilization management

Quality improvement

Clinical coordination

Team collaboration

Formation

MD/DO

Description du poste

Centene is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. You will provide medical leadership for utilization management, cost containment, and care quality initiatives to support members.

You will review complex cases for medical necessity and cooperate with care teams to optimize outcomes. You will help implement performance improvement programs, develop physician education, and