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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose:
Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
Responsibilities include:
- Providing medical leadership for utilization management, cost containment, and medical quality improvement activities.
- Performing medical review activities related to utilization review, quality assurance, and complex or controversial medical services.
- Supporting performance improvement initiatives for capitated providers.
- Assisting in planning and establishing goals to improve quality and cost-effectiveness of care.
- Providing medical expertise in quality improvement and utilization management programs, ensuring compliance with regulations and standards.
- Participating in physician committees and provider network development.
- Conducting rounds for high-risk patient care, collaborating with care teams.
- Reviewing complex claims to determine medical necessity and appropriate payment.
- Developing alliances with the provider community and representing the business unit at public and state committees.
- Supporting weekend and holiday work as needed.
Education/Experience:
Medical Doctor or Doctor of Osteopathy with utilization management experience preferred. Knowledge of quality standards and experience with diverse populations is advantageous.
License/Certifications:
Board certification in a recognized medical specialty and a current California MD or DO license without restrictions.
Additional details:
Pay Range: $231,900 - $440,500 per year. Benefits include health insurance, 401K, tuition reimbursement, paid time off, and flexible work schedules. Centene is an equal opportunity employer committed to diversity.
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