Medical Director (Multiple sites available)
Inpatient and outpatient
Join our growing team at Centene Corporation to expand our Centralized Medicare Unit! We are looking to fill 5 new Medical Directors. You will be partnering with the Chief Medical Director to direct and coordinate the physician component of the utilization management functions for the health plan business units. Provide medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants. Assist Chief Medical Director in planning, 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. Identify utilization review studies and evaluates 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. Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Education/Experience: Requires a MD or DO, board certified preferably in a primary care specialty (Internal Medicine, Family Practice, Emergency Medicine) or other specialty familiar with Medicare patients. Previous experience within a managed care organization is preferred. The candidate must be an actively practicing physician. License/Certifications: Board Certification through American Board Medical Specialties. Current State medical license without restrictions.
Multiple locations available: Chicago, IL, St. Louis, MO, Rego Park, NY, Pheonix, AZ, or Charlotte, NC
Posted December 2, 2020