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Centene Corporation logo
Centene Corporation

Transforming the health of the communities we serve, one person at a time.

Inpatient Medical Director, West Coast

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1984H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

87 days ago

Salary

$236.5K - $449.3K / year

Seniority

Lead

Postgraduate DegreeEnglish

Job Description

Inpatient Medical Director, West Coast

Centene Corporation

• 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 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 • Conducts 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 to improve the quality and cost of care • Interfaces with physicians and other providers to facilitate implementation of recommendations to improve utilization and health care quality • Reviews claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment • Develops alliances with the provider community through the development and implementation of medical management programs • Represents the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues as needed • Represents the business unit at appropriate state committees and other ad hoc committees • May be required to work weekends and holidays as needed.

Job 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.

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

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