Medical Director

November 22

Apply Now

Receive Emails with Similar Jobs

Centene Corporation

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• 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 • 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 clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care • 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

🎯 Requirements

• 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 • 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

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules