Remote Medical Director

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. Perform medical reviews of complex, controversial, or experimental medical services.

Responsibilities

• Support the implementation of performance improvement initiatives for capitated providers.
• Assist 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.
• Assist in the functioning of physician committees, including committee structure, processes, and membership.
• 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, both locally and nationally, on medical philosophy, policies, and related issues.
• Attend state committees and other ad hoc committees as required.
• Work weekends and holidays as needed to support business operations.

Requirements

• 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.
• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Qualifications

• Experience practicing medicine.
• Knowledge of healthcare regulations and accreditation standards.
• Ability to work collaboratively with various healthcare professionals.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.

Skills

• Utilization Management
• Quality Improvement
• Medical Review
• Provider Network Development
• Physician Committee Participation
• Complex Case Review
• Medical Necessity Appeals
• Provider Collaboration
• Public Speaking and Advocacy

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.

Pay

$236,500.00 - $449,300.00 per year

Schedule

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