Remote Behavioral Medical Director, Central Region

Position Purpose

Aid the Chief 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.

Responsibilities

• Support the Chief Medical Director in implementing performance improvement initiatives for capitated providers.
• Assist in planning and establishing goals and policies to enhance quality and cost-effectiveness of care and service for members.
• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
• Collaborate with clinical teams, network providers, appeals team, medical and pharmacy consultants to review complex cases and medical necessity appeals.
• Participate in provider network development and new market expansion as necessary.
• Develop alliances with the provider community through the development and implementation of medical management programs.
• Represent the business unit before various publics on medical philosophy, policies, and related issues.
• Attend appropriate state committees and other ad hoc committees as needed.
• Work weekends and holidays as needed to support business operations.

Requirements

• Medical Doctor or Doctor of Osteopathy degree.
• 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.
• Board certification by the American Board of Psychiatry and Neurology.
• Preferred certification in Child Psychiatry.
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Qualifications

• Active practicing medicine.
• Strong medical expertise in the operation of approved quality improvement and utilization management programs.
• Effective communication and collaboration skills with clinical teams, network providers, and other stakeholders.
• Ability to identify and address utilization review and quality improvement studies to reduce unwarranted variation in clinical practice.
• Knowledge of regulatory, state, corporate, and accreditation requirements.

Skills

• Strong medical leadership and decision-making skills.
• Excellent problem-solving and critical thinking abilities.
• Effective communication and collaboration skills.
• Ability to work independently and as part of a team.
• Proficiency in healthcare policy and regulations.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field or office work schedules.

Pay

$236,500.00 - $449,300.00 per year

Schedule

Flexible work schedule with options for remote, hybrid, field or office work.

Contact Information

Centene Corporation
Address: [Not provided]
Phone: [Not provided]

Equal Opportunity Employer

Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.