Remote Medical Director, Medicare Quality & Utilization

Centene Corporation; Nebraska; Hybrid; USD 215.000 - 409.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements (remote,hyb

Field or office work schedules

Zusammenfassung

Centene Corporation seeks a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing across the business unit. You will guide utilization management, cost containment, and physician education, reviewing complex cases with a focus on clinical excellence.

Collaborating with clinical teams, network providers, and committees, you will help advance quality initiatives and appropriate payment decisions while supporting market

Qualifikationen

• Medical Doctor or DO with board certification preferred.
• Experience in utilization management and quality accreditation standards.
• Active medical practice and exposure to diverse patient populations.
• Course work in health administration, financing or personnel management is advantageous.

Aufgaben

• Direct and coordinate medical management, quality improvement and credentialing.
• Provide medical leadership for utilization management and cost containment.
• Review complex or controversial medical services for medical necessity and payment.
• Collaborate with clinical teams, providers, and consultants on complex cases.
• Assist in provider network development and education on clinical policies.
• Represent the business unit on state committees and public forums when needed.

Ausbildung

Medical Doctor or Doctor of Osteopathy

Utilization Management experience

Quality accreditation standards

Experience treating or managing care for diverse populations

Active medical practice

Health administration course work

Jobbeschreibung

Centene Corporation seeks a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing across the business unit. You will guide utilization management, cost containment, and physician education, reviewing complex cases with a focus on clinical excellence.

Collaborating with clinical teams, network providers, and committees, you will help advance quality initiatives and appropriate payment decisions while supporting market