Medical Director – Part-Time
Centene Corporation
part-time
Posted on:
Location Type: Remote
Location: Mississippi • United States
Visit company websiteExplore more
Salary
💰 $225,700 - $428,900 per year
Job Level
About the role
- Assist the Chief Medical Officer 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, ensuring timely and quality decision making.
- Supports effective implementation of performance improvement initiatives for capitated providers.
- Assists Chief Medical Officer in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
- Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Assists the Chief Medical Officer 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.
- Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Participates in provider network development and new market expansion as appropriate.
- Assists in the development and implementation of physician education with respect to clinical issues and policies.
- Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
- Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
- Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
- 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.
- As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
- Represents 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
- MD or DO without restrictions
- Must be licensed in Mississippi
- Board Certified Physician
- Utilization Management experience and knowledge of quality accreditation standards highly preferred
- Actively practices medicine or has been an actively practicing physician within the last 5 years
Benefits
- 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 & Tools
utilization managementmedical reviewquality assuranceperformance improvementclinical quality improvementmedical necessity determinationprovider network developmentclaims reviewcredentialingcost containment
Soft Skills
collaborationleadershipcommunicationproblem-solvingdecision makingorganizational skillsinterpersonal skillsstrategic planningteam coordinationeducational development
Certifications
MDDOBoard Certified Physicianlicensed in Mississippi