Talent.com
Remote Medical Director

Remote Medical Director

Centene CorporationLadonia, TX, US
Hace 21 horas
Tipo de contrato
  • A tiempo completo
  • A tiempo parcial
  • Teletrabajo
Descripción del trabajo

You 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 : Remote Medical Directors

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 :

  • Licenses MD or DO without restrictions
  • Board certified by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Service (Internal and Family Medicine, preferred)
  • Utilization Management experience and knowledge of quality accreditation standards.
  • Actively practices medicine

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. 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. (Certification in Internal or Family Medicine, preferred.) Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

    Centene 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.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

    Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

    Crear una alerta de empleo para esta búsqueda

    Medical Director • Ladonia, TX, US

    Ofertas relacionadas
    • Oferta promocionada
    Emergency Medicine Medical Director in Paris, TX

    Emergency Medicine Medical Director in Paris, TX

    TeamHealth CorporateParis, TX, US
    Indefinido
    TeamHealth has a great new leadership opportunity in Paris, Texas! TeamHealth currently has an opening for a physician leader who is board eligible or certified in emergency medicine (EM) or board ...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Travel Certified Surgical Technologist

    Travel Certified Surgical Technologist

    Uniti MedParis, TX, US
    A tiempo completo
    Uniti Med is seeking a travel Certified Surgical Technologist for a travel job in Paris, Texas.Job Description & Requirements. Certified Surgical Technologist.Cigna medical, MetLife dental and v...Mostrar másÚltima actualización: hace 4 días
    • Oferta promocionada
    Travel Nurse RN - Med Surg / Telemetry

    Travel Nurse RN - Med Surg / Telemetry

    Health Advocates Network - NursingParis, TX, US
    A tiempo completo
    Health Advocates Network - Nursing is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Paris, Texas. Job Description & Requirements.RN – MS / Tele Registered Nurse ...Mostrar másÚltima actualización: hace 4 días
    • Oferta promocionada
    RN Medical Surgical Telemetry Nights

    RN Medical Surgical Telemetry Nights

    Baylor Scott & White HealthRockwall, TX, US
    A tiempo completo
    Join Baylor Scott and White Medical Center – Lake Pointe as a Registered Nurse and be part of something better! .Our Med Surg unit is a fast-paced environment that includes high ac...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Travel Labor & Delivery RN

    Travel Labor & Delivery RN

    Planet HealthcareParis, TX, US
    A tiempo completo
    Planet Healthcare is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Paris, Texas.Job Description & Requirements. Planet Healthcare Job ID #73702363.Pay package is based...Mostrar másÚltima actualización: hace 11 días
    • Oferta promocionada
    • Nueva oferta
    Remote Medical Director

    Remote Medical Director

    Centene CorporationLadonia, TX, US
    Teletrabajo
    A tiempo completo +1
    You 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 offe...Mostrar másÚltima actualización: hace 2 horas
    • Oferta promocionada
    Travel Orthopedic Inpatient RN

    Travel Orthopedic Inpatient RN

    LifePointParis, TX, US
    A tiempo completo
    LifePoint is seeking a travel nurse RN Orthopedics for a travel nursing job in Paris, Texas.Job Description & Requirements. Paris Regional Medical Center 865 Deshong Dr Paris, TX 75460 • •Orienta...Mostrar másÚltima actualización: hace 4 días
    • Oferta promocionada
    RN Medical Telemetry Float Seasonal

    RN Medical Telemetry Float Seasonal

    Baylor Scott & White HealthRockwall, TX, US
    A tiempo completo +1
    Shift : 13 Week Seasonal Contract Nights, 3-12 hour Shift, 7 : 00AM -7 : 00AM .Our Float Pool unit is a fast-paced environment that includes high acuity medical surgical patients.Are you loo...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Travel Orthopedic Inpatient RN

    Travel Orthopedic Inpatient RN

    Core StaffingParis, TX, US
    A tiempo completo
    Core Staffing is seeking a travel nurse RN Orthopedics for a travel nursing job in Paris, Texas.Job Description & Requirements. Gross Weekly Pay : $1,729 / week based on 36 hours / week.Orientation i...Mostrar másÚltima actualización: hace 4 días
    • Oferta promocionada
    Travel Orthopedic Inpatient RN

    Travel Orthopedic Inpatient RN

    LRS Healthcare - Travel NursingParis, TX, US
    Indefinido
    LRS Healthcare - Travel Nursing is seeking a travel nurse RN Orthopedics for a travel nursing job in Paris, Texas.Job Description & Requirements. LRS Healthcare - Travel Nursing Job ID #30-39891...Mostrar másÚltima actualización: hace 2 días
    • Oferta promocionada
    Physician Director

    Physician Director

    International SOS Government Medical ServicesGreenville, TX, US
    A tiempo completo
    International SOS Government Medical Services, Inc.Founded in 1984, we operate in 92 countries providing integrated medical solutions to organizations with international operations.Our innovative t...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Travel Nurse - RN - MS - Medical Surgical - $1724 / Week - Hiring Now

    Travel Nurse - RN - MS - Medical Surgical - $1724 / Week - Hiring Now

    Stability HealthcareParis, TX, US
    A tiempo completo
    Stability Healthcare is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Paris, TX. Shift : 3x12 hr nights Start Date : ASAP Duration : 13 weeks Pay : $1724...Mostrar másÚltima actualización: hace 7 días
    • Oferta promocionada
    Travel Nurse RN - Med Surg

    Travel Nurse RN - Med Surg

    Go HealthcareParis, TX, US
    A tiempo completo
    Go Healthcare is seeking a travel nurse RN Med Surg for a travel nursing job in Paris, Texas.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours per week (subject...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Travel Labor & Delivery RN

    Travel Labor & Delivery RN

    Premier Medical Staffing ServicesParis, TX, US
    Indefinido
    Premier Medical Staffing Services is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Paris, Texas. Job Description & Requirements.Premier Medical Staffing Job ID #600783...Mostrar másÚltima actualización: hace 11 días
    • Oferta promocionada
    Travel Orthopedic Inpatient RN

    Travel Orthopedic Inpatient RN

    Planet HealthcareParis, TX, US
    A tiempo completo
    Planet Healthcare is seeking a travel nurse RN Orthopedics for a travel nursing job in Paris, Texas.Job Description & Requirements. Planet Healthcare Job ID #73793003.Pay package is based on 12 ...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Travel Orthopedic Inpatient RN

    Travel Orthopedic Inpatient RN

    LeaderStatParis, TX, US
    A tiempo completo +1
    LeaderStat is seeking a travel nurse RN Orthopedics for a travel nursing job in Paris, Texas.Job Description & Requirements. The above pay package is an estimate, please contact our team to put ...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Remote Medical Director- Texas

    Remote Medical Director- Texas

    Centene CorporationLadonia, TX, US
    Teletrabajo
    A tiempo completo +1
    You 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 offe...Mostrar másÚltima actualización: hace 23 horas
    • Oferta promocionada
    RN - Medical / Surgical

    RN - Medical / Surgical

    CHRISTUS HealthSulphur Springs, TX, US
    A tiempo completo
    The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation. Provides routine and complex care, with th...Mostrar másÚltima actualización: hace más de 30 días