Behavioral Health Medical Director

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $225.7k - $428.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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.

📋 Description

• Assist the Sr 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 Sr 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 Sr 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. • Performs other duties as assigned • Complies with all policies and standards

🎯 Requirements

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