Medical Director, Marketplace

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🔥 0 minutes ago

🌾 Iowa, Nebraska, +3 more states – Remote

🌾 Iowa – Remote 🌾 Nebraska – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

💵 $236.5k - $449.3k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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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 Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. • Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. • Perform medical review activities for utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. • Support effective implementation of performance improvement initiatives for capitated providers. • Assist Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness. • Provide medical expertise in the operation of approved quality improvement and utilization management programs. • Conduct regular rounds to assess and coordinate care for high-risk patients. • Collaborate with clinical teams and providers for reviewing complex cases and appeals. • Participate in provider network development and new market expansion. • Assist in the development and implementation of physician education on clinical issues. • Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice. • Interface with physicians and providers to facilitate recommendations for improvement.

🎯 Requirements

• Medical Doctor or Doctor of Osteopathy • Utilization Management experience and knowledge of quality accreditation standards preferred • Actively practices medicine • Course work in 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 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.

🏖️ 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