Medical Director

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $103 - $196 / hour

⏱ Part 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 CMO in directing and coordinating physician utilization management functions for health plan business units • Provide medical leadership for utilization management and medical review activities • Review complex, controversial, experimental, unusual, or new medical services, including transplants • Perform case reviews and appeals for all health plans • Assist the CMO with planning goals and policies to improve quality and cost-effectiveness of care and services • Provide medical expertise for quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements • Identify utilization review studies and evaluate adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy • Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice • Review complex claims to determine medical necessity and appropriate payment • Utilize consultant services when reviewing complex or controversial medical services

🎯 Requirements

• Must be a Board Certified Physician • Medical Doctor or Doctor of Osteopathy • Board certification through American Board Medical Specialties • Current Indiana state medical license without restrictions • Actively practicing physician • Primary care specialty preferred: Internal Medicine, Med/Peds, Family Practice, Pediatrics or Emergency Medicine, or another specialty familiar with Medicare patients • Utilization management experience ideal • Previous experience within a managed care organization preferred • Experience treating or managing care for a culturally diverse population preferred • More than 1 state license preferred • Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management preferred • Availability for roughly 20 hours per week, with Thursdays/Fridays highest priority

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation