Centene is looking for a Remote Behavioral Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing functions. You will provide medical leadership for utilization management, cost containment, and medical quality improvement activities for the business unit.
What You'll Do
- Provide medical leadership for all utilization management, cost containment, and medical quality improvement activities.
- Perform medical reviews for utilization review, quality assurance, and complex, controversial, or experimental medical services.
- Support effective implementation of performance improvement initiatives for capitated providers.
- Assist in planning and establishing goals and policies to improve the quality and cost-effectiveness of care and service.
- Provide medical expertise for quality improvement and utilization management programs, ensuring regulatory compliance.
- Assist in the functioning of physician committees, including their structure, processes, and membership.
- Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams.
- Collaborate with clinical teams, network providers, appeals teams, and consultants to review complex cases and medical necessity appeals.
- Participate in provider network development and new market expansion.
- Assist in developing and implementing physician education on clinical issues and policies.
- Identify utilization review studies and evaluate adverse trends in service usage, provider patterns, and benefit adequacy.
- Identify clinical quality improvement studies to reduce unwarranted practice variation and improve care quality and cost.
- Interface with physicians and providers to facilitate implementation of recommendations improving utilization and healthcare quality.
- Review claims involving complex, controversial, unusual, or new services to determine medical necessity and appropriate payment.
- Develop alliances with the provider community through medical management program development and implementation.
- Represent the business unit before various publics on medical philosophy, policies, and related issues as needed.
- Represent the business unit at appropriate state committees and other ad hoc committees.
- Work weekends and holidays as needed in support of business operations.
What We're Looking For
- MD or DO degree without restrictions.
- American Board certified in Psychiatry.
- Active Board certification by the American Board of Psychiatry and Neurology.
- Active Certification in Psychiatry specialty.
- Current state license as an MD or DO without restrictions, limitations, or sanctions from government programs.
- Actively practices medicine.
Nice to Have
- American Board certified in Child or Addiction Psychiatry.
- Utilization Management experience and knowledge of quality accreditation standards.
- Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management.
- Experience treating or managing care for a culturally diverse population.
Team & Environment
You will assist the Chief Medical Director and report directly to them.
Benefits & Compensation
- 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.
- Compensation: $231,900.00 - $440,500.00 per year.
Work Mode
This is a remote position.
Centene is an equal opportunity employer.
