Centene Corporation logo
Centene Corporation

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

Supervisory Medical Director – National Physical Health Appeals, Outpatient UM

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

Location

Arizona + 4 moreAll locations: Arizona | Kansas | New York | North Carolina | Missouri

Posted

5 days ago

Salary

$236.5K - $449.3K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Supervisory Medical Director – National Physical Health Appeals, Outpatient UM

Centene Corporation

• Provides medical and leadership expertise to ensure high-quality, cost-effective care for our members. • Assists the Senior Medical Director and Chief Medical Officer in execution of operational and strategic clinical initiatives. • Provides operational leadership, coaching and mentorship for a team of front-line medical directors. • Participates in creation and updates to new hire and existing medical director training. • Supports Chief Medical Officer and Sr. Medical Director in the execution of strategic clinical initiatives. • Participates in utilization review studies, performance management and trend analysis. • Handles complex and high-profile utilization management cases, ensuring timely and appropriate decision-making. • Conducts and participates in case escalation reviews, collaborating with healthcare providers and market leadership to resolve disputes and or complaints. • Oversees and actively participates in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements. • Provides clinical guidance and training to appeals medical director team around regulatory updates. • Collaborates closely with clinical teams, UM teams, and network providers to ensure understanding and adherence to utilization management clinical coverage criteria.

Job Requirements

  • Medical Doctor (MD) Graduate of an accredited medical school required
  • Master's Degree MBA, MPH, or epidemiologist degree preferred
  • 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required
  • 1+ years Supervisory/management experience preferred
  • 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 required
  • American Board Certification in Internal or Family Medicine, preferred.
  • MD - Physician - State Licensure Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required

Benefits

  • competitive pay
  • 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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