Clinical Director – Dental
Centene Corporation
Medical Director
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida, Illinois, Nevada, New Hampshire, Oklahoma • 🇺🇸 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
- Supports effective implementation of performance improvement initiatives for capitated providers
- Assists Chief Medical Director 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 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
- 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 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
- May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues
- May be required to work weekends and holidays in support of business operations, as needed
- For NH Substance Use Disorder Physician: Provides clinical oversight and guidance for the MCO on Substance Use Disorder issues; Consults on MCO clinical policy related to Substance Use Disorders
- Performs other duties as assigned; Complies with all policies and standards
Requirements
- Medical Doctor (MD) or Doctor of Osteopathy (DO)
- Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services (Certification in Psychiatry specialty Is required)
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs
- For Behavioral Health only - Board certification by the American Board of Psychiatry and Neurology
- 5+ years of experience working in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting
- Certification in addiction medicine or in the sub-specialty of addiction psychiatry preferred
- For NH Substance Abuse Disorder Physician Only: Board Certification through American Board Medical Specialties; Certification in addiction medicine or in the sub-specialty of addiction psychiatry; Current state medical license without restrictions
- For Nevada only: Board Eligible physician with current state medical license without restrictions; Physician must obtain Board Certification in specialty within reasonable time frame
- For Oklahoma Specialty Children’s Plan only: Board certified and currently licensed in the state of Oklahoma as a child psychiatrist
- For Illinois plan only: Must reside in Illinois; Must have a minimum of eight (8) years of experience in mental health, substance abuse, or children services
- For MHS Indiana only: Indiana-licensed Geriatrician; actively practicing physician; Previous experience within a managed care organization preferred
- DE Only: Psychiatrist or board certified Psychiatric Mental Health Nurse Practitioner or Clinical Nurse Specialist with APN license in the State of Delaware and at least five years of combined experience in mental health and substance use services
- DE LTSS Only: board certified physician with experience in LTSS
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
- Total compensation may also include additional forms of incentives
- Benefits may be subject to program eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical managementutilization managementquality improvementmedical reviewclinical oversightaddiction medicinebehavioral healthclaims reviewprovider network developmentperformance improvement
Soft skills
leadershipcollaborationcommunicationcoordinationproblem-solvinganalytical thinkinginterpersonal skillsgoal settingpolicy developmentteamwork
Certifications
Medical Doctor (MD)Doctor of Osteopathy (DO)Board certification in PsychiatryBoard certification in addiction medicineBoard certification in a medical specialtyCurrent state medical licenseBoard certification by the American Board of Psychiatry and Neurology
