Centene is looking for a Remote Child Behavioral Medical Director to provide essential medical leadership within our behavioral health unit. You will assist the Chief Medical Director in directing medical management, quality improvement, and credentialing functions.

What You'll Do

Provide medical leadership for all utilization management, cost containment, and medical quality improvement activities.
Perform medical review activities pertaining to 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 of care and service for members.
Provide medical expertise in the operation of approved quality improvement and utilization management programs.
Assist the Chief Medical Director in the functioning of physician committees.
Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams.
Collaborate effectively with clinical teams, network providers, and consultants for reviewing complex cases and medical necessity appeals.
Participate in provider network development and new market expansion as appropriate.
Assist in the development and implementation of physician education on clinical issues and policies.
Identify utilization review studies and evaluate adverse trends in utilization of medical services.
Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice.
Interface with physicians and other providers to facilitate implementation of recommendations that improve utilization and health care 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 programs.
Represent the business unit before various publics on medical philosophy and policies.
Represent the business unit at appropriate state and ad hoc committees.
May be required to work weekends and holidays in support of business operations.

What We're Looking For

Medical Doctor or Doctor of Osteopathy degree.
Board certification by the American Board of Psychiatry and Neurology.
Current state license as an MD or DO without restrictions, limitations, or sanctions from government programs.

Nice to Have

Utilization Management experience and knowledge of quality accreditation standards.
Active medical practice.
Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management.
Experience treating or managing care for a culturally diverse population.
Certification in Child Psychiatry.