Medical Director

## Medical DirectorApplylocations: Remote-OKtime type: Full timeposted on: Posted Yesterdayjob requisition id: 1639582You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.**We’re Hiring: Full time Medical Director for our Oklahoma Health Plan!**Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace.Looking for a compelling opportunity to move beyond patient encounters and drive meaningful change in the community?**Qualifications for this role include:*** MD or DO without restrictions* Must be licensed in Oklahoma* Board Certified Physician**Position Purpose:** Assist the Chief Medical Director 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 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 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.**Education/Experience:*** Medical Doctor or Doctor of Osteopathy.* Utilization Management experience and knowledge of quality accreditation standards preferred.* Actively practices medicine or has been an actively practicing physician within the last 5 years.* 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.**License/Certifications:*** 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.* Current Oklahoma state license as a MD or DO without restrictions, limitations, or sanctions from government programs.Pay Range: $215,000.00 - $408,500.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. #J-18808-Ljbffr