Behavioral Health Medical Director
Centene Corporation
Behavioral Medical Director
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • Texas • 🇺🇸 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 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
- Collaborate effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases
- Participates in provider network development and new market expansion as appropriate
- Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
- Develops alliances with the provider community through the development and implementation of the medical management programs
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 by the American Board of Psychiatry and Neurology
- Current Texas 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 assurancemedical managementcost containmentcredentialingclaims reviewmedical necessity determinationhealth administrationhealth financing
Soft skills
leadershipcollaborationcommunicationinterpersonal skillsorganizational skills
Certifications
Medical Doctor (MD)Doctor of Osteopathy (DO)Board certification in Psychiatry and NeurologyTexas state medical license
