Behavioral Health Medical Director

Position Purpose

Aid the Sr Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit. Provide medical leadership in utilization management, cost containment, and medical quality improvement activities. Perform medical reviews of complex, controversial, or experimental medical services to ensure timely and quality decisions.

Qualifications

• Must be licensed in Louisiana
• Board certified by the American Board of Psychiatry and Neurology
• 5+ years of post-residency experience

Position Purpose

Support the Sr Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provide medical expertise in operating approved quality improvement and utilization management programs according to regulatory, state, corporate, and accreditation requirements.

Responsibilities

• Assist in the development and implementation of physician education regarding clinical issues and policies
• Identify utilization review studies and evaluate adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components
• Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice to improve quality and cost of care
• Collaborate with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participate in provider network development and new market expansion as appropriate
• Develop alliances with the provider community through the development and implementation of medical management programs
• Represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues
• Represent the business unit at appropriate state committees and other ad hoc committees
• May be required to work weekends and holidays in support of business operations, as needed

Education/Experience

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

License/Certifications

• Board certification by the American Board of Psychiatry and Neurology
• Current Louisiana state license as a MD or DO without restrictions, limitations, or sanctions from government programs

Pay Range

$225,700.00 - $428,900.00 per year

Benefits

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.