Centene is hiring a Remote Inpatient Medical Director to provide medical leadership and support for key clinical operations. In this role, you will assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions to improve the quality and cost-effectiveness of care.
What You'll Do
- Direct and coordinate medical management, quality improvement, and credentialing functions.
- Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
- Perform medical review activities for utilization review, quality assurance, and review of complex, controversial, or experimental services.
- Support implementation of performance improvement initiatives for capitated providers.
- Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care.
- Provide medical expertise in quality improvement and utilization management programs per regulatory and accreditation requirements.
- Assist in the functioning of physician committees including 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 team, and consultants for reviewing complex cases and appeals.
- Participate in provider network development and new market expansion.
- Assist in development and implementation of physician education on clinical issues and policies.
- Identify utilization review studies and evaluate adverse trends, unusual provider patterns, and adequacy of benefits.
- Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice.
- Interface with physicians and providers to facilitate implementation of recommendations improving utilization and quality.
- Review claims involving complex, controversial, unusual, or new services to determine medical necessity and payment.
- Develop alliances with the provider community through medical management programs.
- Represent the business unit before various publics on medical philosophy, policies, and issues.
- Represent the business unit at appropriate state committees and other ad hoc committees.
- May be required to work weekends and holidays as needed.
What We're Looking For
- Medical Doctor or Doctor of Osteopathy degree.
- Actively practices medicine.
- Active 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.
Nice to Have
- Utilization Management experience.
- 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.
- Certification in Internal or Family Medicine.
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: $236,500.00 - $449,300.00 per year.
Work Mode
This is a fully remote position.
Centene is an equal opportunity employer.
