Provider Network Specialist, Physical Health Enrollment/Maint
Partners Health Management
Chief Medical Officer
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $271,000 - $515,500 per year
Job Level
Lead
About the role
- Provide medical oversight, expertise and leadership to ensure delivery of cost effective, quality healthcare services to health plan members. Serve as clinical advisor and educator of medical management staff ensuring correct clinical judgment. Develop, implement and interpret medical review and quality related policies and guidelines. Provide oversight for staff and provider training and education and promote relations with local medical community. Review case management data, identify trends and gaps in care and recommend corrective actions. Oversee quality of care issues and implement processes for improvement. Monitor performance indicators, member and provider satisfaction and recommend changes. Develop corporate clinical care standards and medical practice policies and provide medical guidance to Medical Management department.
Requirements
- Medical Doctor (MD) or Doctor of Osteopathy required. 7+ years clinical experience in the practice of medicine required. Management experience preferred. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine and provides leadership in the local medical community preferred. Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management preferred. Experience treating or managing care for a culturally diverse population preferred. Board certification in a medical specialty recognized by the American Board of Medical Specialists required. Certification in a primary care specialty preferred. Current Texas state license as a MD or DO without restrictions, limitations or sanctions from government programs required. Must reside in Texas, required.
