Remote Medical Director - South Carolina

RemoteWorker US; Anderson (SC); Remote; USD 221,000 - 421,000; Full time

Job summary

A leading company is seeking a Remote Medical Director to oversee medical management and quality improvement initiatives. The role involves providing medical leadership, conducting reviews, and collaborating with clinical teams to optimize patient care. Candidates must be a Medical Doctor or Doctor of Osteopathy with relevant experience and board certification.

Benefits

Health insurance

401K

Stock plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Qualifications

• Active medical practice required.
• Experience in Utilization Management preferred.
• Board certification in a recognized medical specialty.

Responsibilities

• Direct and coordinate medical management and quality improvement.
• Provide medical leadership for utilization management activities.
• Conduct rounds for high-risk patients and collaborate with care management teams.

Skills

Utilization Management

Medical Leadership

Quality Improvement

Collaboration

Education

Medical Doctor or Doctor of Osteopathy

Coursework in Health Administration

Job description

Remote Medical Director - South Carolina

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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit.

• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental medical services, ensuring timely and quality decision-making.
• Support effective implementation of performance improvement initiatives for capitated providers.
• Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and services for members.
• Provide medical expertise in the operation of quality improvement and utilization management programs, adhering to regulatory, state, corporate, and accreditation standards.
• Assist in physician committee functions, including structure, processes, and membership.
• Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
• Collaborate with clinical teams, network providers, appeals teams, and consultants for complex case reviews and medical necessity appeals.
• Participate in provider network development and market expansion as appropriate.
• Assist in developing and implementing physician education on clinical issues and policies.
• Identify utilization review studies and evaluate adverse trends and provider practice patterns.
• Identify clinical quality improvement opportunities to reduce unwarranted practice variation and improve care quality and cost.
• Facilitate implementation of recommendations to providers to improve utilization and healthcare quality.
• Review claims involving complex or unusual services to determine medical necessity and payment appropriateness.
• Develop alliances with the provider community through medical management programs.
• Represent the business unit at state and national forums on medical philosophy and policies as needed.
• Participate in or represent the business at committees and public engagements.
• Work weekends and holidays as necessary to support operations.

Education/Experience: Medical Doctor or Doctor of Osteopathy. Experience in Utilization Management and knowledge of accreditation standards preferred. Active medical practice required. Coursework in Health Administration, Financing, Insurance, or Personnel Management is advantageous. Experience with diverse populations preferred.

License/Certifications: Board certification in a recognized medical specialty. Valid South Carolina MD or DO license without restrictions or sanctions.

Pay Range: $221,300 - $420,500 annually. Benefits include competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements. Salary may vary based on skills, experience, and other factors. Total compensation may include incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Applicants with criminal records will be considered in accordance with applicable laws.