Remote Medicare Medical Director — Quality & Utilization

Centene Corporation; Colorado; Hybrid; USD 215.000 - 409.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock plan

Tuition reimbursement

Paid time off

Holidays

Flexible work schedule

Zusammenfassung

Centene Corporation seeks a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

You will lead utilization management, cost containment, and medical quality initiatives, perform reviews for complex cases, and support performance improvements across capitated providers, aligning with regulatory and accreditation standards.

Qualifikationen

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Actively practices medicine.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Aufgaben

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities related to utilization review, quality assurance, and medical review of complex or controversial services.
• Support implementation of performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care for members.
• Offer medical expertise for quality improvement and utilization management programs in line with regulations.
• Assist Chief Medical Director with the physician committees' structure, processes, and membership.
• Conduct rounds to assess care for high-risk patients and coordinate with care management teams.

Ausbildung

Medical Doctor or Doctor of Osteopathy

Utilization Management experience

Actively practices medicine

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

Experience with diverse populations

Jobbeschreibung

Centene Corporation seeks a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

You will lead utilization management, cost containment, and medical quality initiatives, perform reviews for complex cases, and support performance improvements across capitated providers, aligning with regulatory and accreditation standards.