Talent.com
Remote Medical Director
Remote Medical DirectorCentene Corporation • Florissant, MO, US
No longer accepting applications
Remote Medical Director

Remote Medical Director

Centene Corporation • Florissant, MO, US
6 days ago
Job type
  • Full-time
  • Part-time
  • Remote
Job description

Job Description

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

    Create a job alert for this search

    Medical Director • Florissant, MO, US

    Related jobs
    Senior Medical Director

    Senior Medical Director

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for a Senior Medical Director, Clinical Development.Key Responsibilities : Supports the development of clinical trial protocols and oversees the conduct of clinical trials Pr...Show more
    Last updated: 30+ days ago • Promoted
    Medical Director - Hematology / Oncology

    Medical Director - Hematology / Oncology

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for a Global Safety Medical Director specializing in Hematology / Oncology.Key Responsibilities Validate safety signals and lead safety signal assessments Develop and maintain...Show more
    Last updated: 5 days ago • Promoted
    Washington Licensed Medical Director

    Washington Licensed Medical Director

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for an Internist, ABIM / AOBIM Medical Director (Remote / Full Time).Key Responsibilities : Conduct regular case reviews to ensure compliance with CMS NCD / LCD guidelines Assist i...Show more
    Last updated: 4 days ago • Promoted
    Medical Director

    Medical Director

    American Red Cross • St. Louis, MO, United States
    Full-time
    Please use Google Chrome or Mozilla Firefox when accessing Candidate Home.By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spi...Show more
    Last updated: 23 days ago • Promoted
    Medical Director

    Medical Director

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for a Medical Director to oversee clinical documentation and coding compliance for inpatient charts. Key Responsibilities Provide clinical leadership and maintain collaborativ...Show more
    Last updated: 4 days ago • Promoted
    Associate Medical Director, MA Licensed

    Associate Medical Director, MA Licensed

    VirtualVocations • Florissant, Missouri, United States
    Full-time
    A company is looking for an Associate Medical Director- Radioligand Therapy.Key Responsibilities : Provide medical / scientific leadership on imaging-related projects and serve as a liaison to clien...Show more
    Last updated: 5 days ago • Promoted
    Arizona Licensed Medical Director

    Arizona Licensed Medical Director

    VirtualVocations • Saint Louis, Missouri, United States
    Full-time
    A company is looking for a Medical Director responsible for overseeing medical staff services and ensuring compliance with healthcare regulations. Key Responsibilities Provide medical oversight an...Show more
    Last updated: 30+ days ago • Promoted
    Medical Director - Family Medicine

    Medical Director - Family Medicine

    VirtualVocations • Florissant, Missouri, United States
    Full-time
    A company is looking for a UM Medical Director specializing in Family Medicine, Internal Medicine, or Sports Medicine, to work remotely. Key Responsibilities : Conduct coverage reviews and render c...Show more
    Last updated: 5 days ago • Promoted
    Maryland Licensed Medical Director

    Maryland Licensed Medical Director

    VirtualVocations • Saint Louis, Missouri, United States
    Full-time
    A company is looking for a Health Plan Medical Director Physician.Key Responsibilities Participate in the development and execution of case management, disease management, and population health m...Show more
    Last updated: 29 days ago • Promoted
    State Licensed Medical Director

    State Licensed Medical Director

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for a Medical Director (Aetna One Advocate).Key Responsibilities Partner with Advocate team members to assess member needs holistically Lead clinical staff in coordinating q...Show more
    Last updated: 30+ days ago • Promoted
    State Licensed Senior Medical Director

    State Licensed Senior Medical Director

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for a Senior Medical Director of Geriatric Psychiatry Services.Key Responsibilities Lead and oversee psychiatric teams providing telehealth care to older adults with serious ...Show more
    Last updated: 30+ days ago • Promoted
    Hospital Medicine Medical Director

    Hospital Medicine Medical Director

    Sound Physicians • Bridgeton, MO, Saint Louis County, MO; Missouri, United States
    Full-time
    Shape the future of healthcare in St Louis, Missouri by becoming our next Hospital Medicine Medical Director at SSM DePaul!. We believe in bringing “better” to our local community in Bridgeton, Miss...Show more
    Last updated: 1 day ago • Promoted
    Medical Director Physician

    Medical Director Physician

    MEDS : Midwest Emergency Dept. Serv. • Maryville, IL, US
    Full-time
    MEDS operates a renowned network of emergency physician and APP peers across both rural and urban communities in the Midwest. As a physician-owned practice founded in 1983, MEDS offers the care stan...Show more
    Last updated: 30+ days ago • Promoted
    New Jersey Licensed Behavioral Medical Director

    New Jersey Licensed Behavioral Medical Director

    VirtualVocations • Saint Louis, Missouri, United States
    Full-time
    A company is looking for a Behavioral Medical Director for the East Region, working remotely.Key Responsibilities Oversee and direct the Utilization Management Program, ensuring delivery of quali...Show more
    Last updated: 5 days ago • Promoted
    New York Licensed Behavioral Medical Director

    New York Licensed Behavioral Medical Director

    VirtualVocations • Saint Charles, Missouri, United States
    Full-time
    A company is looking for a Behavioral Medical Director - Remote.Key Responsibilities Oversee and guide the Utilization Management team, ensuring cost-effective quality care Implement Level of Ca...Show more
    Last updated: 30+ days ago • Promoted
    DC and MD Licensed Medical Director

    DC and MD Licensed Medical Director

    VirtualVocations • Saint Louis, Missouri, United States
    Full-time
    A company is looking for a Lead Medical Director for Utilization Management.Key Responsibilities Oversee the execution of case management, disease management, and utilization review operations C...Show more
    Last updated: 2 days ago • Promoted
    Medical Director

    Medical Director

    Theoria Medical • Florissant, MO, US
    Full-time
    Leading the charge in healthcare innovation, Theoria Medical offers a unique blend of medical excellence and technological advancement, primarily serving the post-acute and primary care sectors.Our...Show more
    Last updated: 30+ days ago • Promoted
    Inpatient Care Management Medical Director - Missouri residence - Remote

    Inpatient Care Management Medical Director - Missouri residence - Remote

    UnitedHealth Group • St. Louis, MO, United States
    Remote
    Full-time
    Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives.The work you do with our team will directly improve health outcomes by connec...Show more
    Last updated: 30+ days ago • Promoted