Senior Medical Director

Job not on LinkedIn

🔥 15 hours ago

🗻 New Hampshire – Remote

🗻 New Hampshire – Remote

💵 $215k - $408.5k / year

⏰ Full Time

🟠 Senior

👨‍⚕️ Medical Director

👻 Ghost score 0%

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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 Vice President of Medical Affairs in directing and coordinating medical affairs functions for the business unit • Oversee the denials and appeals department • Serve as clinical executive leader representing the health plan internally and externally • Lead clinical escalations, state fair hearings, and health plan advocacy with the New Hampshire Department of Health and Human Services • Provide medical leadership for utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement • Perform utilization review, quality assurance, and medical review of complex, controversial, or experimental services • Support performance improvement initiatives for capitated providers • Assist in planning goals and policies to improve quality and cost-effectiveness of care • Provide medical expertise for quality improvement and utilization management programs • Support physician committee structure, processes, and membership • Oversee physician advisors and other medical directors • Utilize medical and pharmacy consultants for complex cases and medical necessity appeals • Participate in provider network development, new market expansion, and provider profiling initiatives • Develop and implement physician education regarding clinical issues and policies • Identify utilization review and clinical quality improvement studies and evaluate adverse utilization trends and provider practice patterns • Interface with physicians and providers to implement recommendations improving utilization and healthcare quality • Review complex, controversial, unusual, or new-service claims for medical necessity and appropriate payment • Develop provider-community alliances through medical management programs • Represent the business unit before public audiences and state or ad hoc committees • Oversee appeals and denials department budgetary, policy, and personnel decisions • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Medical Doctor or Doctor of Osteopathy • 7+ years of clinical experience in the practice of medicine • Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services • Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs • Actively practices medicine • The Senior Medical Director must be located in New Hampshire or willing to relocate • Managed care or ACO leadership experience strongly preferred • Management experience preferred • Utilization Management experience and knowledge of quality accreditation standards preferred • Active American Board Certification in Internal or Family Medicine preferred • Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous • Experience treating or managing care for a culturally diverse population preferred • Must work flexible hours, including weekends and holidays, as needed

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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