Remote Medical Director - Part-Time Utilization & Quality

Centene Corp.; Indiana; Remote; USD 142,000 - 271,000; Part time

Job summary

Centene Corp seeks a Medical Director PRN to support the CMO in directing the physician component of utilization management for the health plan units. The position is remote in Indiana, part-time (~20 hours/week), with Thursdays and Fridays as the highest priority. Board-certified MD/DO with an active Indiana license and utilization management experience is required. Will lead reviews, appeals, and quality-improvement efforts.

Qualifications

• Requires Medical Doctor or Doctor of Osteopathy; board certified.
• Active Indiana medical license required; multiple state licenses preferred.
• Utilization management experience preferred.
• Experience in managed care settings is advantageous.

Responsibilities

• Provide medical leadership for utilization management and medical review activities, including utilization review, quality assurance, and review of complex or experimental services with consultants.
• Perform case reviews and appeals for all health plans.
• Assist CMO in planning and setting goals to improve quality and cost-effectiveness of care.
• Offer medical expertise for operating approved quality improvement and utilization management programs in line with regulatory and accreditation standards.
• Identify utilization review studies and monitor adverse utilization trends.
• Identify clinical quality improvement opportunities to reduce unwarranted practice variation.
• Review claims involving complex or unusual services to determine medical necessity and appropriate payment.

Skills

Utilization management experience

Medical leadership

Active practicing physician

Education

MD or DO

Board Certification (ABMS)

Job description

Centene Corp seeks a Medical Director PRN to support the CMO in directing the physician component of utilization management for the health plan units. The position is remote in Indiana, part-time (~20 hours/week), with Thursdays and Fridays as the highest priority. Board-certified MD/DO with an active Indiana license and utilization management experience is required. Will lead reviews, appeals, and quality-improvement efforts.