Medical and health services manager Jobs in Tacoma, WA

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.

Position Purpose : The Behavioral Health Medical Director provides clinical leadership and support of the Chief Medical Director to direct and coordinate the behavioral health medical management, quality improvement and credentialing functions for the business unit.

• Participates in performance and quality based on changes in the healthcare or medical arena.
• Fosters Clinical Practice Guideline implementation and evidence-based medical practice.
• Interprets existing policies and participates in developing new policies.
• Participates as needed in regulatory, professional and community activities to provide input and become knowledgeable regarding regulatory, professional and community standards and issues.
• Ensures that the medical care provided meets the standards for acceptable medical care.
• Develops, Implements and Conducts concurrent and retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.
• Leads, develops, directs and implements clinical and non-clinical development of Program implementation following State directives and guidelines
• Develops, Implements and Conducts the evaluation of authorization requests in timely manner and provide support for the CM and RN reviewers and manages the denial process
• Performs other duties as assigned
• Complies with all policies and standards

Education / Experience :

Medical Doctor (MD) required

10+ years of clinical experience required

2+ years of Behavioral Health managed care experience required

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) required

Doctorate Degree in Medicine required

Board Certified in Psychiatry (ABPN) required

License / Certification :

Doctorate Degree in Medicine. Washington state license as a MD without restrictions, limitations, or sanctions fromgovernment programs. Board certification by the American Board of Psychiatry and Neurology. Additional board certification in child andadolescent psychiatry and / or Addiction Medicine highly preferred

Pay Range : $210,800.00 - $400,500.00 per year

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. Total compensation may also include additional forms of incentives.

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