Medical Director, Inpatient Medicare
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $231,900 - $440,500 per year
Job Level
Lead
About the role
- Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
- Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities
- Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services
- Supports effective implementation of performance improvement initiatives for capitated providers
- Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
- Assists in the development and implementation of physician education with respect to clinical issues and policies
- Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
- Represents the business unit at appropriate state committees and other ad hoc committees.
Requirements
- Medical Doctor or Doctor of Osteopathy
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Actively practices medicine
- 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 preferred
- Board certification in Internal Medicine or Family Medicine and recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization managementmedical reviewquality assuranceperformance improvementmedical necessity determinationcost containmentcredentialingclinical education
Soft skills
collaborationleadershipcommunication
Certifications
Medical Doctor (MD)Doctor of Osteopathy (DO)Board certification in Internal MedicineBoard certification in Family Medicine