Remote Medical Director of Pharmacy Quality & Utilization

Centene Corporation; Kentucky; Hybride; USD 237 000 - 449 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work options

Résumé du poste

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing across the business unit. You will provide medical leadership for utilization management, care quality initiatives, and reviews of complex services to ensure timely, high-quality decisions.

You will collaborate with care management teams, network providers, and committees to improve outcomes, support performance improvement, and align

Qualifications

• MD or DO
• 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 is 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 review activities for utilization review, quality assurance, and complex/controversial services
• Support performance improvement initiatives for capitated providers
• Assist planning and establishing goals to improve quality and cost-effectiveness of care
• Provide medical expertise in quality improvement and utilization management programs
• Assist in physician committees: structure, processes, and membership
• Conduct rounds to assess care for high-risk patients with care management teams
• Collaborate with clinical teams, network providers, appeals team, and consultants on complex cases
• Participate in provider network development and new market expansion
• Assist in physician education regarding clinical issues and policies
• Identify utilization review studies and monitor trends in utilization and payment components
• Identify clinical quality improvement studies to reduce unwarranted variation
• Interface with providers to implement recommendations for utilization and quality
• Review claims for medical necessity and appropriate payment
• Develop alliances with the provider community through medical management programs
• May represent the unit before publics and on state committees
• May work weekends/holidays as needed

Connaissances

Active medical practice

Utilization management

Quality improvement

Diversity experience

Formation

MD/DO

Health admin/fin/insurance courses

Description du poste

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing across the business unit. You will provide medical leadership for utilization management, care quality initiatives, and reviews of complex services to ensure timely, high-quality decisions.

You will collaborate with care management teams, network providers, and committees to improve outcomes, support performance improvement, and align