Centene Management Company LLC is seeking a Remote Outpatient Medical Director to provide essential clinical leadership. In this role, you will assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit.

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 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, including structure, processes, and membership.
Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams.
Collaborate effectively with clinical teams, network providers, appeals team, 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, unusual provider practice patterns, and adequacy of benefit/payment components.
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 to improve 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 the development and implementation of medical management programs.
May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
Represent the business unit at appropriate state committees and other ad hoc committees.
May be required to work weekends and holidays in support of business operations, as needed.

What We're Looking For

Medical Doctor (MD) or Doctor of Osteopathy (DO).
Actively practices 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 an MD or DO without restrictions, limitations, or sanctions from government programs.

Nice to Have

Utilization Management experience and knowledge of quality accreditation standards.
Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
Experience treating or managing care for a culturally diverse population.
Certification in Internal or Family Medicine.