Supervisory Medical Director – National Physical Health Appeals, Outpatient UM

🔥 33 minutes ago

🌵 Arizona, Kansas, +3 more states – Remote

🌵 Arizona – Remote 🌪️ Kansas – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏰 Missouri – Remote

💵 $236.5k - $449.3k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Provides medical and leadership expertise to ensure high-quality, cost-effective care for our members. • Assists the Senior Medical Director and Chief Medical Officer in execution of operational and strategic clinical initiatives. • Provides operational leadership, coaching and mentorship for a team of front-line medical directors. • Participates in creation and updates to new hire and existing medical director training. • Supports Chief Medical Officer and Sr. Medical Director in the execution of strategic clinical initiatives. • Participates in utilization review studies, performance management and trend analysis. • Handles complex and high-profile utilization management cases, ensuring timely and appropriate decision-making. • Conducts and participates in case escalation reviews, collaborating with healthcare providers and market leadership to resolve disputes and or complaints. • Oversees and actively participates in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements. • Provides clinical guidance and training to appeals medical director team around regulatory updates. • Collaborates closely with clinical teams, UM teams, and network providers to ensure understanding and adherence to utilization management clinical coverage criteria.

🎯 Requirements

• Medical Doctor (MD) Graduate of an accredited medical school required • Master's Degree MBA, MPH, or epidemiologist degree preferred • 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required • 1+ years Supervisory/management experience preferred • 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 required • American Board Certification in Internal or Family Medicine, preferred. • MD - Physician - State Licensure Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required

🏖️ 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