Health eCareers
Overview
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Remote Medical Director - Indiana
role at
Health eCareers . Work with Centene as a clinical professional on the Medical Management/Health Services team to impact 28 million members. Centene provides competitive benefits and flexible workplace options. Were Hiring: Remote Medical Directors Centene Corporation is a leading provider of government-sponsored healthcare coverage, delivering access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace. Responsibilities
Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Conduct medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Support performance improvement initiatives for capitated providers. Assist 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 in accordance with regulatory, state, corporate, and accreditation requirements. Assist the Chief Medical Director in physician committee functioning, structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborate with clinical teams, network providers, appeals team, and medical/pharmacy consultants for reviewing complex cases and medical necessity appeals. Participate in provider network development and new market expansion as appropriate. Contribute to 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 reduce unwarranted variation in clinical practice and improve quality and cost of care. Interface with physicians and other providers to implement recommendations that improve utilization and health care quality. Review claims involving complex or new services to determine medical necessity and appropriate payment. Develop alliances with the provider community through medical management program implementation. Represent the business unit before various publics on medical philosophy, policies, and related issues as needed. 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. Qualifications
Education/Experience Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population is preferred. License/Certifications Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Associations Department of Certifying Board Services. Current Indiana state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Benefits & Compensation
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Total compensation may include additional incentives and varies based on skills, experience, and status. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws and regulations. Employment Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care
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Join to apply for the
Remote Medical Director - Indiana
role at
Health eCareers . Work with Centene as a clinical professional on the Medical Management/Health Services team to impact 28 million members. Centene provides competitive benefits and flexible workplace options. Were Hiring: Remote Medical Directors Centene Corporation is a leading provider of government-sponsored healthcare coverage, delivering access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace. Responsibilities
Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Conduct medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Support performance improvement initiatives for capitated providers. Assist 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 in accordance with regulatory, state, corporate, and accreditation requirements. Assist the Chief Medical Director in physician committee functioning, structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborate with clinical teams, network providers, appeals team, and medical/pharmacy consultants for reviewing complex cases and medical necessity appeals. Participate in provider network development and new market expansion as appropriate. Contribute to 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 reduce unwarranted variation in clinical practice and improve quality and cost of care. Interface with physicians and other providers to implement recommendations that improve utilization and health care quality. Review claims involving complex or new services to determine medical necessity and appropriate payment. Develop alliances with the provider community through medical management program implementation. Represent the business unit before various publics on medical philosophy, policies, and related issues as needed. 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. Qualifications
Education/Experience Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population is preferred. License/Certifications Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Associations Department of Certifying Board Services. Current Indiana state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Benefits & Compensation
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Total compensation may include additional incentives and varies based on skills, experience, and status. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws and regulations. Employment Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care
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