Child Behavioral Medical Director
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $236,500 - $449,300 per year
Job Level
About the role
- Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit
- 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, ensuring timely and quality decision making
- 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
- Assist the Chief Medical Director in the functioning of the 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 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
- Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care
- Interface with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality
- Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
- Develop alliances with the provider community through the development and implementation of the medical management programs
- May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues
- Represent the business unit at appropriate state committees and other ad hoc committees
- May be required to work weekends and holidays in support of business operations, as needed
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
- Active American Board certification in Child Psychiatry, preferred
- 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 improvementclinical quality improvementmedical necessity determinationprovider network developmentcare managementcost containmentcredentialing
Soft skills
medical leadershipcollaborationcommunicationdecision makinggoal settingproblem solvinginterpersonal skillsorganizational skillsteamworkcultural competency
Certifications
Medical Doctor (MD)Doctor of Osteopathy (DO)Board certification in PsychiatryBoard certification in Child Psychiatry