Talent.com
Remote Medical Director - California HealthNet
Remote Medical Director - California HealthNetCentene Corporation • California, US
Remote Medical Director - California HealthNet

Remote Medical Director - California HealthNet

Centene Corporation • California, US
4 days ago
Job type
  • Full-time
  • Part-time
  • Remote
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 • California, US

    Related jobs
    Physician / Medical Director / California / Locum tenens / Part-Time Medical Director in Fresno, CA Job

    Physician / Medical Director / California / Locum tenens / Part-Time Medical Director in Fresno, CA Job

    Samuel Contract Staffing LLC • Fresno, CA, United States
    Part-time
    Part-Time Medical Director Needed in Fresno, CAWe work with a plasma donation center in Fresno, CA.We have an open position for a Medical Director (MD or DO) to join us 4 hours a week.No specialty ...Show more
    Last updated: 30+ days ago • Promoted
    Physician / Medical Director / California / Permanent / Medical Director Job

    Physician / Medical Director / California / Permanent / Medical Director Job

    Samuel Contract Staffing LLC • Visalia, CA, US
    Full-time
    NOW HIRING : Medical Director - Visalia, CA Our company is one of the worlds largest makers of plasma products.We collect human plasma from paid donors to make medicines that are used to treat patie...Show more
    Last updated: 30+ days ago • Promoted
    Hospital Medicine Medical Director

    Hospital Medicine Medical Director

    Sound Physicians • Clovis, US
    Full-time
    Transform patient care and the community as a Medical Director in Clovis, New Mexico.Our mission in Clovis is to provide “. Ready to grow your career in a place that values community and colla...Show more
    Last updated: 30+ days ago • Promoted
    Pathology Anatomic and Clinical Medical Director - Fresno, CA

    Pathology Anatomic and Clinical Medical Director - Fresno, CA

    Trinity Health • Fresno, US
    Part-time
    Saint Agnes Medical Providers (SAMP) is a physician-led 120+ provider multispecialty group.Pathology Anatomic and Clinical Medical Director. The selected candidate will lead the pathology laboratory...Show more
    Last updated: 27 days ago • Promoted
    Pathology Anatomic and Clinical Medical Director - Fresno, CA

    Pathology Anatomic and Clinical Medical Director - Fresno, CA

    HealthEcareers - Client • Fresno, CA, USA
    Part-time
    Saint Agnes Medical Providers (SAMP) is a physician-led 120+ provider multispecialty group.Pathology Anatomic and Clinical Medical Director. The selected candidate will lead the pathology laboratory...Show more
    Last updated: 27 days ago • Promoted
    Clinical Director

    Clinical Director

    Telecare Corporation • Sanger, CA, United States
    Full-time
    Clinical Director - Sanger Place.They made it easier for me to live, breathe, eat, and stay clean.Without them, I'd be waiting somewhere, waiting for someone to give me a chance to live.Client from...Show more
    Last updated: 18 days ago • Promoted
    Medical Director (Pathologist)

    Medical Director (Pathologist)

    Samuel Contract Staffing • Visalia, California, United States
    Part-time
    Quick Apply
    Would you like to supplement your income? If so, we’re looking for a Medical Director (Pathologist) to join us part-time at our plasma donation center in Visalia, CA!. Contracted Limited Part-time : ...Show more
    Last updated: 30+ days ago
    Medical Director

    Medical Director

    Covelo Direct • Fresno, CA, United States
    Full-time
    Physician – Urgent Care / Occupational Medicine.Multiple Sites Across California.Eligible for Sign-On, Quarterly, and Monthly Performance Bonuses. Urgent Care and Occupational Medicine clinics.Calif...Show more
    Last updated: 13 days ago • Promoted
    Physician / Medical Director / California / Locum tenens / Part-Time Medical Director in Fresno, CA

    Physician / Medical Director / California / Locum tenens / Part-Time Medical Director in Fresno, CA

    Samuel Contract Staffing LLC • Fresno, CA, US
    Part-time
    Part-Time Medical Director Needed in Fresno, CAWe work with a plasma donation center in Fresno, CA.We have an open position for a Medical Director (MD or DO) to join us 4 hours a week.No specialty ...Show more
    Last updated: 30+ days ago • Promoted
    Chief Medical Director

    Chief Medical Director

    Los Angeles County Department of Human Resources • CA, United States
    Full-time
    Los Angeles County Department of Human Resources.Be among the first 25 applicants.Los Angeles County Department of Human Resources. Get AI-powered advice on this job and more exclusive features.Los ...Show more
    Last updated: 30+ days ago • Promoted
    Quality Assistant Medical Director - Emergency Medicine - Kaweah Health Medical Center

    Quality Assistant Medical Director - Emergency Medicine - Kaweah Health Medical Center

    Vituity • Visalia, CA, United States
    Full-time
    Visalia, CA - Seeking Quality Assistant Medical Director Join the Physician Partnership Where You Can Increase Your Impact Vituity's ownership model provides autonomy, local control, and a nation...Show more
    Last updated: 30+ days ago • Promoted
    Family Medicine Residency Program Director - Tulare, CA

    Family Medicine Residency Program Director - Tulare, CA

    HealthEcareers - Client • Tulare, CA, USA
    Full-time
    Adventist Health Tulare is seeking an experienced and visionary leader to serve as.Family Medicine Residency Program.This is a unique opportunity to shape the future of primary care by mentoring th...Show more
    Last updated: 30+ days ago • Promoted
    Assistant Medical Director - Emergency Medicine - Adventist Health Selma

    Assistant Medical Director - Emergency Medicine - Adventist Health Selma

    Vituity • Selma, CA, US
    Full-time
    Selma, CA – Seeking Emergency Medicine Assistant Medical Director.Join the Physician Partnership Where You Can Increase Your Impact. Vituity’s ownership model provides autonomy, local co...Show more
    Last updated: 30+ days ago • Promoted
    Associate Medical Director, Clinical Development

    Associate Medical Director, Clinical Development

    Arrowhead Pharmaceuticals • Fresno, CA, United States
    Full-time
    Arrowhead Pharmaceuticals, Inc.Nasdaq : ARWR) is a clinical stage biopharmaceutical company that develops medicines that treat intractable diseases by silencing the genes that cause them.Using a bro...Show more
    Last updated: 13 days ago • Promoted
    Physician / Chief Medical Officer / California / Locum or Permanent / Director Of Surgical Services Job

    Physician / Chief Medical Officer / California / Locum or Permanent / Director Of Surgical Services Job

    Radius Staffing Solutions • Tulare, CA, United States
    Permanent
    Our client located in the state of California is looking for a permanent Nurse Director to oversee Surgical Services.Ideal candidates should 2+ years of surgical services experience with at least 1...Show more
    Last updated: 30+ days ago • Promoted
    Regional Sales Director - California Region- Remote

    Regional Sales Director - California Region- Remote

    Freedom Energy Logistics LLC • CA, USA
    Remote
    Full-time
    Quick Apply
    Regional Sales Director – California.Join Freedom Energy Logistics, a premier energy advisory services firm leading the dynamic energy sector evolution. We offer unparalleled growth opportunit...Show more
    Last updated: 30+ days ago
    Medical Director Physician - Competitive Salary

    Medical Director Physician - Competitive Salary

    DocCafe • California, US
    Full-time
    DocCafe has an immediate opening for the following position : Physician - Medical Director in California.DocCafe is the premier physician and advanced practice job board to help you advance your hea...Show more
    Last updated: 30+ days ago • Promoted
    Medical Director Physician

    Medical Director Physician

    Adventist Health • Tulare, CA, US
    Full-time
    Adventist Health Tulare is seeking an experienced and visionary leader to serve as.Family Medicine Residency Program.This is a unique opportunity to shape the future of primary care by mentoring th...Show more
    Last updated: 30+ days ago • Promoted