Remote Medical Director, Pharmacy & Utilization Leadership

Centene Corporation; Olympia (WA); Hybrid; USD 237.000 - 449.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Zusammenfassung

Centene Corporation seeks a physician leader to oversee utilization management, quality improvement, and medical review for complex services. The role requires an MD or DO who actively practices medicine and holds board certification in a relevant specialty.

You will collaborate with care teams, networks, and appeal specialists to ensure cost-effective, high-quality care for members, including regulatory adherence and provider education.

Qualifikationen

• MD/DO required and actively practices medicine.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Course work in Health Administration, Health Financing, Insurance, or Personnel Management is advantageous.
• Experience managing care for culturally diverse populations preferred.

Aufgaben

• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities for utilization review, quality assurance, and complex or new services reviews.
• Assist in planning and implementing performance improvement initiatives and education for providers.
• Collaborate with clinical teams, network providers, appeals team, and consultants on complex cases and medical necessity appeals.
• Represent the business unit before public committees and stake holders as needed.

Kenntnisse

Medical leadership

Utilization management

Quality improvement

Medical review

Team collaboration

Ausbildung

MD/DO

Board certification

Jobbeschreibung

Centene Corporation seeks a physician leader to oversee utilization management, quality improvement, and medical review for complex services. The role requires an MD or DO who actively practices medicine and holds board certification in a relevant specialty.

You will collaborate with care teams, networks, and appeal specialists to ensure cost-effective, high-quality care for members, including regulatory adherence and provider education.