Remote Medical Director - California

Health Net; California (MO); Remote; USD 231,000 - 441,000; Full time

Job summary

An established industry player seeks a Remote Medical Director to lead medical management and quality improvement initiatives. This pivotal role involves providing medical leadership, collaborating with clinical teams, and enhancing care quality for diverse populations. The ideal candidate will hold an MD or DO, possess strong utilization management experience, and be committed to improving health outcomes. With a competitive salary and comprehensive benefits, this opportunity offers the chance to make a significant impact on the health of millions while enjoying workplace flexibility.

Benefits

Health Insurance

401K

Stock Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Active medical practice required with a focus on utilization management.
• Experience with diverse populations is preferred.

Responsibilities

• Provide medical leadership for utilization management and quality improvement.
• Collaborate with clinical teams on complex cases and appeals.
• Conduct rounds to assess care for high-risk patients.

Skills

Utilization Management

Medical Leadership

Quality Improvement

Collaboration with Clinical Teams

Decision-Making

Education

Medical Doctor (MD) or Doctor of Osteopathy (DO)

Coursework in Health Administration

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 in directing and coordinating the medical management, quality improvement, and credentialing functions for the business unit.

Responsibilities include:

1. Providing medical leadership for utilization management, cost containment, and medical quality improvement activities.
2. Performing medical review activities related to utilization review, quality assurance, and complex or controversial medical services, ensuring timely and quality decision-making.
3. Supporting performance improvement initiatives for capitated providers.
4. Helping establish goals and policies to improve quality and cost-effectiveness of care.
5. Providing medical expertise in quality improvement and utilization management programs in compliance with regulatory standards.
6. Assisting in the functioning of physician committees, including structure, processes, and membership.
7. Conducting rounds to assess and coordinate care for high-risk patients.
8. Collaborating with clinical teams, providers, and consultants on complex cases and appeals.
9. Participating in provider network development and market expansion.
10. Supporting physician education on clinical issues and policies.
11. Identifying utilization review studies and evaluating adverse trends.
12. Identifying clinical quality improvement opportunities to reduce unwarranted practice variation.
13. Facilitating implementation of recommendations to providers.
14. Reviewing claims for complex or unusual services to determine medical necessity and payment appropriateness.
15. Developing alliances with the provider community through medical management programs.
16. Representing the business unit at public and state committees as needed.
17. May require working weekends and holidays to support operations.

Education and 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 is advantageous. Experience with diverse populations is preferred.

Licenses and Certifications

Board certification in a recognized medical specialty and a current, unrestricted California medical license (MD or DO).

Additional Details

Pay Range: $231,900 - $440,500 annually.

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

Centene is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will be considered without regard to protected characteristics.