Remote Medical Director, Pharmacy
Centene Corporation · United States · 1 mo ago
RemoteRemoteHealthcare$237k–$449k/yrFull-time
We need to output HTML fragment only, with headings for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. No Job ID etc. Remove boilerplate: EEO, equal opportunity, scam warning, navigation, legal, etc. Also remove duplicated lines. Preserve all substantive info.
We need to parse the posting.
Let's extract sections:
Position Purpose: description of role. Could be "About the role" or maybe "Responsibilities". The purpose is basically responsibilities. We'll treat as "About the role" maybe.
Then list of duties: many bullet-like sentences. We'll put under
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. No Job ID etc. Remove boilerplate: EEO, equal opportunity, scam warning, navigation, legal, etc. Also remove duplicated lines. Preserve all substantive info.
We need to parse the posting.
Let's extract sections:
Position Purpose: description of role. Could be "About the role" or maybe "Responsibilities". The purpose is basically responsibilities. We'll treat as "About the role" maybe.
Then list of duties: many bullet-like sentences. We'll put under Responsibilities
with - each.
Then Education/Experience: that's qualifications/requirements. Could be under
Requirements
or Qualifications
. We'll decide: Use Requirements for education/experience, Qualifications for license/certifications maybe. But we can combine. The instruction: prefer few substantive sections over many thin ones. So maybe we have sections: About the role (purpose), Responsibilities (list of duties), Requirements (education/experience + license/certifications), Benefits, Pay. Schedule maybe not present except mention "May be required to work weekends and holidays". That's schedule info. So we can include Schedule section with that detail.
Pay: we have Pay Range.
Benefits: we have description of benefits package.
We must not include sections with filler like "commensurate with experience". Not present.
We must not include duplicated lines.
Let's extract content.
Position Purpose paragraph:
"Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.Supports effective implementation of performance improvement initiatives for capitated providers.Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.Assists the Chief Medical Director in the functioning of the 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.Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.Participates in provider network development and new market expansion as appropriate.Assists in the development and implementation of physician education with respect to clinical issues and policies.Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.Develops alliances with the provider community through the development and implementation of the medical management programs.As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.Represents 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."
We can split into About the role (maybe first sentence) and Responsibilities (list). But we can also treat the whole as About the role and then list responsibilities separately. However we need to avoid duplication. Could put About the role as a brief summary: "Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities." Then responsibilities list the rest.
But we must preserve all substantive info; we can't omit any. So we need to include all sentences somewhere. If we split, we must ensure no omission.
Simplify: Use About the role for a brief overview (first two sentences). Then Responsibilities for the rest (starting from "Performs medical review activities...").
Let's extract first two sentences: "Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities."
Now responsibilities list: each sentence after that.
Let's list them:
- Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.
- Supports effective implementation of performance improvement initiatives for capitated providers.
- Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
- Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Assists the Chief Medical Director in the functioning of the 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.
- Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Participates in provider network development and new market expansion as appropriate.
- Assists in the development and implementation of physician education with respect to clinical issues and policies.
- Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
- Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
- Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
- Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
- Develops alliances with the provider community through the development and implementation of the medical management programs.
- As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
- Represents 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.
Now Education/Experience:
"Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred."
License/Certifications:
"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.Certification in Internal or Family Medicine, preferred.Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs."
We can combine Education/Experience and License/Certifications into a Requirements section (or Qualifications). Let's make Requirements include education/experience and license/certifications.
Now 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."
Also earlier: "At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday." This is more about company culture; could be part of About the role or maybe a separate section? But we have no specific heading for culture; we could incorporate into About the role as additional description. However we must not invent sections; we can add to About the role.
But we already used About the role for brief overview; we could extend it with those sentences. However we must not duplicate. Let's decide: About the role will include the purpose paragraph plus the company culture sentences. That seems okay.
But we must ensure we don't repeat content elsewhere. The purpose paragraph we already used partially for About the role (first two sentences). If we add more sentences to About the role, we need to avoid duplication with Responsibilities. We'll keep About the role as a paragraph that includes the purpose and company culture sentences. Then Responsibilities list the detailed duties (excluding the purpose sentences we already used). However we used first two sentences for About the role; we must not repeat them in Responsibilities. So we will omit those two from Responsibilities list.
Thus About the role content:
"Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday."
Now Responsibilities list will start from "Performs medical review activities..." and go through all the rest, excluding the two sentences we used.
Check if any of the responsibility sentences duplicate the About the role sentences: they don't.
Now Requirements section: combine education/experience and license/certifications.
We need to list as - items maybe.
Education/Experience sentences:
- Medical Doctor or Doctor of Osteopathy.
- Utilization Management experience and knowledge of quality accreditation standards preferred.
- Actively practices medicine.
- Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
- Experience treating or managing care for a culturally diverse population preferred.
License/Certifications:
- 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.
- Certification in Internal or Family Medicine, preferred.
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.
We can combine.
Now Benefits section: list items.
Benefits paragraph: "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."
We could turn into list: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, flexible approach to work (remote, hybrid, field or office). We'll keep as
- each.
Pay section: "Pay Range: $236,500.00 - $449,300.00 per year". Also note: "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." This is substantive; we should include in Pay section.
Thus Pay section will have the range and additional notes.
Schedule section: we have "May be required to work weekends and holidays in support of business operations, as needed." This is already in Responsibilities? Actually we removed that sentence from Responsibilities because we used it? Wait we used the sentence "May be required to work weekends and holidays in support of business operations, as needed." in the original position purpose paragraph at the end. We did not include it in About the role (we only used first two sentences
Requirements
orQualifications
. We'll decide: Use Requirements for education/experience, Qualifications for license/certifications maybe. But we can combine. The instruction: prefer few substantive sections over many thin ones. So maybe we have sections: About the role (purpose), Responsibilities (list of duties), Requirements (education/experience + license/certifications), Benefits, Pay. Schedule maybe not present except mention "May be required to work weekends and holidays". That's schedule info. So we can include Schedule section with that detail. Pay: we have Pay Range. Benefits: we have description of benefits package. We must not include sections with filler like "commensurate with experience". Not present. We must not include duplicated lines. Let's extract content. Position Purpose paragraph: "Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.Supports effective implementation of performance improvement initiatives for capitated providers.Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.Assists the Chief Medical Director in the functioning of the 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.Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.Participates in provider network development and new market expansion as appropriate.Assists in the development and implementation of physician education with respect to clinical issues and policies.Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.Develops alliances with the provider community through the development and implementation of the medical management programs.As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.Represents 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." We can split into About the role (maybe first sentence) and Responsibilities (list). But we can also treat the whole as About the role and then list responsibilities separately. However we need to avoid duplication. Could put About the role as a brief summary: "Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities." Then responsibilities list the rest. But we must preserve all substantive info; we can't omit any. So we need to include all sentences somewhere. If we split, we must ensure no omission. Simplify: Use About the role for a brief overview (first two sentences). Then Responsibilities for the rest (starting from "Performs medical review activities..."). Let's extract first two sentences: "Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities." Now responsibilities list: each sentence after that. Let's list them: - Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. - Supports effective implementation of performance improvement initiatives for capitated providers. - Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. - Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. - Assists the Chief Medical Director in the functioning of the 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. - Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. - Participates in provider network development and new market expansion as appropriate. - Assists in the development and implementation of physician education with respect to clinical issues and policies. - Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. - Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. - Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. - Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. - Develops alliances with the provider community through the development and implementation of the medical management programs. - As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. - Represents 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. Now Education/Experience: "Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred." License/Certifications: "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.Certification in Internal or Family Medicine, preferred.Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs." We can combine Education/Experience and License/Certifications into a Requirements section (or Qualifications). Let's make Requirements include education/experience and license/certifications. Now 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." Also earlier: "At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday." This is more about company culture; could be part of About the role or maybe a separate section? But we have no specific heading for culture; we could incorporate into About the role as additional description. However we must not invent sections; we can add to About the role. But we already used About the role for brief overview; we could extend it with those sentences. However we must not duplicate. Let's decide: About the role will include the purpose paragraph plus the company culture sentences. That seems okay. But we must ensure we don't repeat content elsewhere. The purpose paragraph we already used partially for About the role (first two sentences). If we add more sentences to About the role, we need to avoid duplication with Responsibilities. We'll keep About the role as a paragraph that includes the purpose and company culture sentences. Then Responsibilities list the detailed duties (excluding the purpose sentences we already used). However we used first two sentences for About the role; we must not repeat them in Responsibilities. So we will omit those two from Responsibilities list. Thus About the role content: "Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday." Now Responsibilities list will start from "Performs medical review activities..." and go through all the rest, excluding the two sentences we used. Check if any of the responsibility sentences duplicate the About the role sentences: they don't. Now Requirements section: combine education/experience and license/certifications. We need to list as- items maybe.
Education/Experience sentences:
- Medical Doctor or Doctor of Osteopathy.
- Utilization Management experience and knowledge of quality accreditation standards preferred.
- Actively practices medicine.
- Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
- Experience treating or managing care for a culturally diverse population preferred.
License/Certifications:
- 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.
- Certification in Internal or Family Medicine, preferred.
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.
We can combine.
Now Benefits section: list items.
Benefits paragraph: "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."
We could turn into list: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, flexible approach to work (remote, hybrid, field or office). We'll keep as
- each. Pay section: "Pay Range: $236,500.00 - $449,300.00 per year". Also note: "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." This is substantive; we should include in Pay section. Thus Pay section will have the range and additional notes. Schedule section: we have "May be required to work weekends and holidays in support of business operations, as needed." This is already in Responsibilities? Actually we removed that sentence from Responsibilities because we used it? Wait we used the sentence "May be required to work weekends and holidays in support of business operations, as needed." in the original position purpose paragraph at the end. We did not include it in About the role (we only used first two sentences