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Remote Medical Director - California
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RemoteWorker US . Get AI-powered advice on this job and more exclusive features. 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: Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental medical services. Support the 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 in accordance with regulatory and accreditation standards. Assist in the functioning of physician committees, including structure, processes, and membership. Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care management teams. Collaborate with clinical teams, network providers, and other stakeholders for reviewing complex cases and appeals. Participate in provider network development and market expansion as appropriate. Assist in physician education regarding clinical issues and policies. Identify utilization review studies and evaluate trends and provider practices. Identify clinical quality improvement opportunities to enhance care quality and reduce unwarranted variation. Interface with providers to facilitate implementation of recommendations to improve utilization and quality. Review claims involving complex or unusual services for medical necessity and payment appropriateness. Develop alliances with the provider community through management programs. Represent the business unit at public forums and committees as needed. May work weekends and holidays to support operations, as needed.
Education/Experience:
Medical Doctor or Doctor of Osteopathy with utilization management experience and knowledge of accreditation standards preferred. Actively practices medicine. Coursework in health administration, financing, insurance, or personnel management is advantageous. Experience with diverse populations is preferred. License/Certifications:
Board certification in a recognized medical specialty. Current unrestricted California MD or DO license. Additional Details:
Pay Range: $231,900.00 - $440,500.00 per year. Centene offers comprehensive benefits including health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements. Actual pay depends on skills, experience, and education. Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. #J-18808-Ljbffr
Remote Medical Director - California
role at
RemoteWorker US . Get AI-powered advice on this job and more exclusive features. 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: Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental medical services. Support the 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 in accordance with regulatory and accreditation standards. Assist in the functioning of physician committees, including structure, processes, and membership. Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care management teams. Collaborate with clinical teams, network providers, and other stakeholders for reviewing complex cases and appeals. Participate in provider network development and market expansion as appropriate. Assist in physician education regarding clinical issues and policies. Identify utilization review studies and evaluate trends and provider practices. Identify clinical quality improvement opportunities to enhance care quality and reduce unwarranted variation. Interface with providers to facilitate implementation of recommendations to improve utilization and quality. Review claims involving complex or unusual services for medical necessity and payment appropriateness. Develop alliances with the provider community through management programs. Represent the business unit at public forums and committees as needed. May work weekends and holidays to support operations, as needed.
Education/Experience:
Medical Doctor or Doctor of Osteopathy with utilization management experience and knowledge of accreditation standards preferred. Actively practices medicine. Coursework in health administration, financing, insurance, or personnel management is advantageous. Experience with diverse populations is preferred. License/Certifications:
Board certification in a recognized medical specialty. Current unrestricted California MD or DO license. Additional Details:
Pay Range: $231,900.00 - $440,500.00 per year. Centene offers comprehensive benefits including health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements. Actual pay depends on skills, experience, and education. Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. #J-18808-Ljbffr