Medical Director

🕒 May 21

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $215k - $408.5k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

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.

📋 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 • 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 • Conduct regular rounds to assess and coordinate care for high-risk patients • 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. • Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.

🎯 Requirements

• MD or DO without restrictions • Must be licensed in Oklahoma • Board Certified Physician • Utilization Management experience and knowledge of quality accreditation standards preferred • Actively practices medicine or has been an actively practicing physician within the last 5 years • 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.

🏖️ Benefits

• 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