National Medical Director, Neonatology
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
- Drive innovative, member-centric solutions designed to shape the future of neonatal care
- Collaborate with stakeholders and connect thought partners to help bridge strategy and clinical delivery outcomes
- Assist the Deputy Chief Health Officer to direct and coordinate medical management, quality improvement and credentialing functions
- Provide medical leadership of all 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
- Support effective implementation of performance improvement initiatives for capitated providers
- Assist 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
- Conduct regular rounds to assess and coordinate care for high-risk patients
- Collaborate effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
- Participate in provider network development and new market expansion as appropriate
- Assist in the development and implementation of physician education with respect to clinical issues and policies
- Identify utilization review studies and evaluate adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components
- Develop 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 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 Neonatology 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 improvementcredentialingcost containmentclinical deliveryperformance improvementmedical managementprovider network developmentphysician education
Soft skills
collaborationleadershipcommunicationstrategic thinkingproblem-solvinginterpersonal skillsorganizational skillscultural competency
Certifications
Medical Doctor (MD)Doctor of Osteopathy (DO)Board certification in Neonatology