Remote Part-Time Medical Director - Utilization

Centene Corp.; Indiana; Remote; USD 142,000 - 271,000; Part time

Job summary

Centene Corp. seeks a Medical Director (PRN) to assist the CMO in directing physician utilization management for the health plan units. The role is roughly 20 hours per week with Thursdays and Fridays as the highest priority.

Board-certified MD/DO with Indiana license and utilization management experience are required, with a focus on improving care quality and cost-effectiveness. The position involves medical leadership for utilization management activities, medical review, case reviews, and

Qualifications

• Requires MD or DO board certified, Indiana license, and utilization management experience.
• Experience in managed care is preferred.
• Active medical practice status in Indiana is required.

Responsibilities

• Provide medical leadership for utilization management activities and medical review.
• Perform case reviews and appeals for all health plans.
• Assist CMO in planning goals and policies to improve quality and cost-effectiveness.
• Identify utilization review studies and evaluate adverse trends.
• Review complex or new services for medical necessity and payment appropriateness.

Skills

Utilization management

Medical leadership

Quality improvement

Leadership

Education

MD or DO

Board certification (ABMS)

Job description

Centene Corp. seeks a Medical Director (PRN) to assist the CMO in directing physician utilization management for the health plan units. The role is roughly 20 hours per week with Thursdays and Fridays as the highest priority.

Board-certified MD/DO with Indiana license and utilization management experience are required, with a focus on improving care quality and cost-effectiveness. The position involves medical leadership for utilization management activities, medical review, case reviews, and