Remote Medical Director - South Carolina

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

Job summary

A leading company in healthcare is seeking a Remote Medical Director to oversee medical management and quality improvement activities. This role involves providing medical leadership, conducting reviews, and collaborating with clinical teams to enhance care quality for diverse populations. Candidates should possess an MD or DO and relevant experience in utilization management.

Benefits

Comprehensive health insurance

401K

Stock plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Qualifications

• MD or DO with utilization management experience preferred.
• Actively practices medicine.
• Experience with diverse populations preferred.

Responsibilities

• Direct and coordinate medical management and quality improvement.
• Provide medical leadership for utilization management.
• Conduct regular rounds to assess high-risk patients.

Skills

Medical leadership

Utilization management

Quality improvement

Collaboration

Clinical expertise

Education

MD or DO

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.

1. Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
2. Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental services, ensuring timely and quality decisions.
3. Support performance improvement initiatives for capitated providers.
4. Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care.
5. Provide medical expertise in quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
6. Assist in the functioning of physician committees, including structure, processes, and membership.
7. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
8. Collaborate with clinical teams, network providers, appeals team, and consultants for reviewing complex cases and appeals.
9. Participate in provider network development and new market expansion as appropriate.
10. Assist in developing and implementing physician education on clinical issues and policies.
11. Identify utilization review studies and evaluate adverse trends, provider practice patterns, and benefit/payment components.
12. Identify clinical quality improvement studies to reduce unwarranted variation and improve care quality and cost.
13. Interface with providers to facilitate implementation of recommendations to improve utilization and quality.
14. Review claims involving complex or unusual services to determine medical necessity and payment appropriateness.
15. Develop alliances with the provider community through medical management programs.
16. Represent the business unit before various publics and committees as needed.
17. May work weekends and holidays to support operations.

Education/Experience: MD or DO, with utilization management experience and knowledge of accreditation standards preferred. Actively practices medicine. Coursework in health administration, financing, insurance, or personnel management is advantageous. Experience with diverse populations is preferred.

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

Pay Range: $221,300 - $420,500 annually.

Centene offers comprehensive benefits including pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements. Compensation is adjusted based on skills, experience, and other factors.

Centene is an equal opportunity employer committed to diversity, considering all qualified applicants regardless of protected characteristics. Applicants with arrest or conviction records will be considered per applicable laws.