Centene Corporation
Remote Child Behavioral Medical Director
Centene Corporation, Nevada, Iowa, United States, 50201
Remote Child Behavioral Medical Director
Join to apply for the
Remote Child Behavioral Medical Director
role at
Centene Corporation . Centene is a leading provider of government-sponsored healthcare coverage, offering access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace. This remote, executive-level medical leadership role focuses on medical management, quality improvement, and credentialing within the Medical Management/Health Services team. Responsibilities
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform 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 effective implementation of performance improvement initiatives for capitated providers. Assist the 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 in accordance with regulatory, state, corporate, and accreditation requirements. Assist in the functioning of physician committees including committee 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. Assist in physician education regarding clinical issues and policies. Identify utilization review studies and evaluate trends in utilization, provider practice patterns, and benefit/payment adequacy. Identify clinical quality improvement studies to reduce unwarranted variation and improve quality and cost of care. Interface with physicians and providers to implement recommendations that improve utilization and health care quality. Review claims involving complex or unusual services to determine medical necessity and appropriate payment. Develop alliances with the provider community through medical management programs. May represent the business unit before public groups or state committees on medical philosophy, policies, and related issues. May be required to work weekends and holidays in support of business operations, as needed. Qualifications
MD or DO without restrictions. American Board certification in Child/Adolescent Psychiatry (ABPN). Utilization Management experience and knowledge of quality accreditation standards. Active medical practice. Education/Experience
Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications
Board certification by the American Board of Psychiatry and Neurology. Certification in Child Psychiatry is required. Current state MD or DO license without restrictions, limitations, or sanctions from government programs. Compensation and Benefits
Pay Range $231,900.00 - $440,500.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office). Equal Opportunity
Centene is an equal opportunity employer that is committed to diversity and values differences. All qualified applicants will receive consideration regardless of 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.
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Join to apply for the
Remote Child Behavioral Medical Director
role at
Centene Corporation . Centene is a leading provider of government-sponsored healthcare coverage, offering access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace. This remote, executive-level medical leadership role focuses on medical management, quality improvement, and credentialing within the Medical Management/Health Services team. Responsibilities
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform 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 effective implementation of performance improvement initiatives for capitated providers. Assist the 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 in accordance with regulatory, state, corporate, and accreditation requirements. Assist in the functioning of physician committees including committee 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. Assist in physician education regarding clinical issues and policies. Identify utilization review studies and evaluate trends in utilization, provider practice patterns, and benefit/payment adequacy. Identify clinical quality improvement studies to reduce unwarranted variation and improve quality and cost of care. Interface with physicians and providers to implement recommendations that improve utilization and health care quality. Review claims involving complex or unusual services to determine medical necessity and appropriate payment. Develop alliances with the provider community through medical management programs. May represent the business unit before public groups or state committees on medical philosophy, policies, and related issues. May be required to work weekends and holidays in support of business operations, as needed. Qualifications
MD or DO without restrictions. American Board certification in Child/Adolescent Psychiatry (ABPN). Utilization Management experience and knowledge of quality accreditation standards. Active medical practice. Education/Experience
Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications
Board certification by the American Board of Psychiatry and Neurology. Certification in Child Psychiatry is required. Current state MD or DO license without restrictions, limitations, or sanctions from government programs. Compensation and Benefits
Pay Range $231,900.00 - $440,500.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office). Equal Opportunity
Centene is an equal opportunity employer that is committed to diversity and values differences. All qualified applicants will receive consideration regardless of 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.
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