Talent.com
Remote Medical Director - California HealthNet
Remote Medical Director - California HealthNetCentene Corporation • Dos Palos, CA, US
No longer accepting applications
Remote Medical Director - California HealthNet

Remote Medical Director - California HealthNet

Centene Corporation • Dos Palos, CA, US
6 hours 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 :

  • California License 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
  • Managed Care and Medi-Cal experience, preferred

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

    Pay Range : $231,900.00 - $440,500.00 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, 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 • Dos Palos, CA, US

    Related jobs
    Regional Director of Diagnostic Imaging

    Regional Director of Diagnostic Imaging

    Tenet Healthcare • Turlock, CA, US
    Full-time
    Focus on the core content of the job post, remove extra metadata, and ensure formatting is beautiful and consistent with title case.Show more
    Last updated: 30+ days ago • Promoted
    Physician / Anesthesiology / California / Locum Tenens / Locums / Anesthesiology / Job / California Job

    Physician / Anesthesiology / California / Locum Tenens / Locums / Anesthesiology / Job / California Job

    MD Staff, LLC • Turlock, CA, US
    Full-time
    An anesthesiologist is needed in California.The physician must be vaccinated for Covid in the state of California.The candidate must also be able and willing to cover Trauma.An active CA license is...Show more
    Last updated: 30+ days ago • Promoted
    Director - Radiology Technologist - $62-100 per hour

    Director - Radiology Technologist - $62-100 per hour

    Tenet North Cal • Turlock, CA, US
    Full-time
    Tenet North Cal is seeking a Radiology Technologist Director for a job in Turlock, California.Job Description & Requirements. Welcome to Emanuel Medical Center .Since 1917, Emanuel has been the ...Show more
    Last updated: 25 days ago • Promoted
    Director, Quality & Patient Safety (Acute Clinician)

    Director, Quality & Patient Safety (Acute Clinician)

    Sutter Health • Los Banos, CA, US
    Full-time
    Works as part of the senior operations leadership team to accelerate the measurable and continual progress in meeting the organization's quality and patient safety objectives.Works collaboratively ...Show more
    Last updated: 30+ days ago • Promoted
    Assistant Medical Director - Emergency Medicine - Emanuel Medical Center

    Assistant Medical Director - Emergency Medicine - Emanuel Medical Center

    Vituity • Turlock, CA, United States
    Full-time
    Up to $150K Sign On Bonus – Central Valley, CA – Seeking Emergency Medicine Assistant Medical Director Join the Physician Partnership Where You Can Increase Your Impact Vituity’s ownership mode...Show more
    Last updated: 4 hours ago • Promoted • New!
    Market Director

    Market Director

    Boomers Consulting, LLC • Turlock, CA, United States
    Full-time +1
    Market Director Women's and Children Services.Turlock, United States | Posted on 08 / 14 / 2025.Boomers Consulting, LLC provides consulting and staffing services to clients who need assistance with pro...Show more
    Last updated: 30+ days ago • Promoted
    Assistant Medical Director - Emergency Medicine - Memorial Hospital Los Banos

    Assistant Medical Director - Emergency Medicine - Memorial Hospital Los Banos

    Vituity • Los Banos, CA, US
    Full-time
    Los Banos, CA – Seeking Emergency Medicine Assistant Medical Director.Join the Physician Partnership Where You Can Increase Your Impact. Vituity's ownership model provides autonomy, local control, a...Show more
    Last updated: 14 days ago • Promoted
    Physician / Pediatrics / California / Permanent / Pediatrics Physician " Merced, California - J1 & H

    Physician / Pediatrics / California / Permanent / Pediatrics Physician " Merced, California - J1 & H

    Integrity Healthcare... • Merced, CA, US
    Permanent
    Join our dedicated team in Merced, where we are proud to serve our local community and provide expert pediatric primary care in our neighborhood. Our team of physicians and nurse practitioners offer...Show more
    Last updated: 30+ days ago • Promoted
    Medical Assistant

    Medical Assistant

    Ultimate Staffing • Merced, CA, US
    Full-time
    Ultimate Staffing Services is seeking a dedicated Medical Assistant to join a dynamic team in the North Valley region of California. This role requires a compassionate and detail-oriented individual...Show more
    Last updated: 12 days ago • Promoted
    Physician / Pathology / California / Permanent / Physician - Pathology in California Job

    Physician / Pathology / California / Permanent / Physician - Pathology in California Job

    VISTA Staffing Solutions • Merced, CA, United States
    Permanent
    Are you a Pathologist, searching for your next perm position? This position with one of VISTA s healthcare partners in Northern, Californiamight just be the opportunity for you! Opportunity Highlig...Show more
    Last updated: 30+ days ago • Promoted
    Regional Director of Diagnostic Imaging

    Regional Director of Diagnostic Imaging

    Emanuel Medical Ctr • TURLOCK, California, United States
    Full-time
    Welcome to Emanuel Medical Center.Since 1917, Emanuel has been the heart of healthcare in Turlock, California, providing incredible high-quality care with compassion to the patients we serve.We are...Show more
    Last updated: 30+ days ago • Promoted
    Director Medical Staff Services

    Director Medical Staff Services

    Common Spirit Health • Merced, CA, US
    Full-time
    Director Medical Staff Services.Mercy Medical Center Merced, Merced, California.The posted compensation range of $44.CommonSpirit in good faith believes it might pay for this particular job, based ...Show more
    Last updated: 30+ days ago • Promoted
    Medical Director, Health Services (On-site)

    Medical Director, Health Services (On-site)

    University of California - Merced • Merced, CA, United States
    Full-time +1
    The University of California, Merced is required to provide a reasonable estimate of the compensation range for this role. This range takes into account the wide range of factors that are considered...Show more
    Last updated: 30+ days ago • Promoted
    Regional Director of Diagnostic Imaging Bonus Eligible (Full-Time, Days)

    Regional Director of Diagnostic Imaging Bonus Eligible (Full-Time, Days)

    K.A. Recruiting • Turlock, CA, US
    Full-time
    Regional Director Of Diagnostic Imaging.A full-time Regional Director Of Diagnostic Imaging role is available in Turlock, California. This leadership position is perfect for an experienced imaging p...Show more
    Last updated: 30+ days ago • Promoted
    RN - Telemetry in Merced, California - $2,291 / week

    RN - Telemetry in Merced, California - $2,291 / week

    Vetted • Merced, CA, United States
    Full-time
    Vetted is seeking a RN - Telemetry for a travel job in Merced, California.The job was posted 10 days ago.The assignment starts on ASAP and is 13 weeks long with 9 hour shifts 4 days a week.You must...Show more
    Last updated: 4 hours ago • Promoted • New!
    Claims Director

    Claims Director

    Central California Alliance for Health • Merced, CA, United States
    Full-time +1
    Join Us in Strengthening Care in Our Communities! Bring your vision and innovation to claims processing and help transform care for over 400,000 neighbors in five counties.We welcome applicants fro...Show more
    Last updated: 30+ days ago • Promoted
    Medicare Medical Director (MD)

    Medicare Medical Director (MD)

    Central California Alliance for Health • Merced, CA, United States
    Full-time +1
    This is a hybrid position with the expectation to work in our service area(s) 2-3 days per week.The Alliance service area includes Santa Cruz, Monterey, Merced, San Benito, and Mariposa counties.We...Show more
    Last updated: 30+ days ago • Promoted
    RN

    RN

    Dignity Health • Merced, CA, United States
    Full-time
    Job Summary And Responsibilities.Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirec...Show more
    Last updated: 5 hours ago • Promoted • New!
    Back-Up Medical Director

    Back-Up Medical Director

    Samuel Contract Staffing • Merced, California, United States
    Part-time
    Quick Apply
    Would you like to supplement your income? If so, we’re looking for a back-up Medical Director (Pathologist) to join us part-time at our plasma donation center in Merced, CA!.We’re a leading plasma ...Show more
    Last updated: 30+ days ago
    Physician / Internal Medicine / California / Permanent / Primary Care w / Central CA Multi-Specialty J

    Physician / Internal Medicine / California / Permanent / Primary Care w / Central CA Multi-Specialty J

    ARCH • Los Banos, CA, US
    Permanent
    Position Basics : Primary care / internal medicine with excellent and well-established multi-specialty groupNew facilities and equipmentWeekday 8a-5p scheduleGrowing practice with large patient baseBen...Show more
    Last updated: 30+ days ago • Promoted