Remote Medical Director, Pharmacy & Utilization Management

Centene Corporation; United States; Hybrid; USD 237,000 - 449,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote,Hybrid

Office/field options

Job summary

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the unit. The role includes oversight of utilization management, medical reviews, performance improvement initiatives, and coordination with care management teams to improve patient outcomes.

The candidate should hold an MD or DO with current licensure, board certification in a medical specialty, and experience in utilization management

Qualifications

• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Active medical practice required or ongoing.
• Board certification in a medical specialty recognized by ABMS or AOA preferred.
• Current state MD/DO license without restrictions.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing functions.
• Provide medical leadership for utilization management, cost containment and quality improvement activities.
• Review complex or controversial medical services for medical necessity and appropriate payment.
• Assist in provider education on clinical issues and policies.
• Coordinate care for high-risk patients with care management teams and review outcomes.

Skills

Utilization Management experience

Medical leadership

Quality improvement

Cultural competence

Education

Medical Doctor or Doctor of Osteopathy

Course work in Health Administration/Health Financing/Insurance/Personnel Management

Job description

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the unit. The role includes oversight of utilization management, medical reviews, performance improvement initiatives, and coordination with care management teams to improve patient outcomes.

The candidate should hold an MD or DO with current licensure, board certification in a medical specialty, and experience in utilization management