Remote Medical Director - South Carolina

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

Job summary

A leading healthcare company seeks a Remote Medical Director in South Carolina. The role involves directing medical management and quality improvement initiatives, ensuring compliance with standards, and providing leadership in utilization management. Ideal candidates will have an MD or DO, board certification, and experience with diverse populations.

Benefits

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work arrangements

Qualifications

• MD or DO with utilization management experience.
• Board certification in a recognized specialty.
• Knowledge of accreditation standards.

Responsibilities

• Provide medical leadership for utilization management and quality improvement.
• Ensure compliance with regulatory and accreditation standards.
• Conduct rounds for high-risk patients.

Skills

Utilization management

Quality improvement

Medical leadership

Compliance

Education

MD or DO

Board certification

Valid South Carolina license

Job description

Remote Medical Director - South Carolina

Join to apply for the Remote Medical Director - South Carolina role at RemoteWorker US.

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

Responsibilities include:

1. Providing medical leadership for utilization management, cost containment, and quality improvement activities.
2. Performing medical reviews related to utilization, quality assurance, and complex or controversial services.
3. Supporting performance improvement initiatives for capitated providers.
4. Helping establish goals and policies to enhance quality and cost-effectiveness of care.
5. Ensuring compliance with regulatory, state, corporate, and accreditation standards in quality and utilization management programs.
6. Participating in physician committees and provider network development.
7. Conducting rounds for high-risk patients and collaborating with care teams.
8. Reviewing complex claims and medical necessity appeals.
9. Developing alliances with providers and representing the business unit at public and state committees.

Education/Experience: MD or DO with utilization management experience and knowledge of accreditation standards. Board certification in a recognized specialty and a valid South Carolina license are required. Experience with diverse populations is preferred.

Compensation & Benefits: Salary range of $221,300 to $420,500 annually, with comprehensive benefits including health insurance, 401K, tuition reimbursement, paid time off, and flexible work arrangements.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will be considered without regard to protected characteristics.