Behavioral Medical Director

🕒 il y a 2 mois

🌲 North Carolina, Ohio, +2 états de plus – Distant

🌲 North Carolina – Remote 🏈 Ohio – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote

💵 $236 500 - $449 300 / an

⏰ Temps Plein

🔴 Expert

👨‍⚕️ Directeur Médical

👻 Score fantôme 29%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Centene Corporation

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1984

🛡️ Assurance

💼 Conseil

🏥 Santé

Insurance • Consulting • Healthcare

La société Centene Corporation est un leader dans la fourniture de services de santé subventionnés par le gouvernement, spécialisée dans la délivrance de solutions de santé abordables et de haute qualité. Depuis plus de 40 ans, Centene s’est concentrée sur la transformation de la santé des communautés en élargissant l'accès aux services de Medicaid, Medicare, et au marché de l'assurance santé, tout en servant les communautés militaires à travers le programme TRICARE. En tant que plus grande organisation de gestion des soins Medicaid et un acteur clé du marché, Centene met l'accent sur une prestation de soins de santé localisée combinée à des partenariats solides avec des organisations à but non lucratif pour répondre aux besoins uniques de ses membres. Centene s’engage également pour le développement durable et la responsabilité sociale des entreprises, en privilégiant la gestion environnementale et la gouvernance éthique afin d'améliorer le bien-être des communautés qu’elle dessert.

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 • 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

🎯 Exigences

• 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 by the American Board of Psychiatry and Neurology • Certification in Child Psychiatry, preferred • Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs

🏖️ Avantages

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