Talent.com
Registered Nurse
Registered NurseCentene Corporation • Palos Verdes Estates, CA, US
Registered Nurse

Registered Nurse

Centene Corporation • Palos Verdes Estates, CA, US
8 days ago
Job type
  • Full-time
  • Part-time
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

    Registered Nurse • Palos Verdes Estates, CA, US

    Related jobs
    Travel Nurse - Registered Nurse - CVICU - Cardiovascular Intensive Care Unit - $2453 / Week

    Travel Nurse - Registered Nurse - CVICU - Cardiovascular Intensive Care Unit - $2453 / Week

    LRS Healthcare - Nursing • Tarzana, CA, US
    Full-time
    LRS Healthcare - Nursing is seeking an experienced Cardiovascular Intensive Care Unit Registered Nurse for an exciting Travel Nursing job in Tarzana, CA. Shift : Inquire Start Date : 12 / 08 / 2025 Durati...Show more
    Last updated: 17 hours ago • Promoted • New!
    Travel Outpatient Oncology Registered Nurse

    Travel Outpatient Oncology Registered Nurse

    Anders Group • Westlake Village, CA, US
    Full-time
    Anders Group is seeking a travel nurse RN Oncology for a travel nursing job in Westlake Village, California.Job Description & Requirements. Pay package is based on 8 hour shifts and 40 hours per...Show more
    Last updated: 23 days ago • Promoted
    Travel Outpatient Oncology Registered Nurse

    Travel Outpatient Oncology Registered Nurse

    Ethos Medical Staffing • Westlake Village, CA, US
    Full-time
    Ethos Medical Staffing is seeking a travel nurse RN Oncology for a travel nursing job in Westlake Village, California.Job Description & Requirements. Ethos Medical Staffing Job ID #34625744.Pay ...Show more
    Last updated: 16 days ago • Promoted
    Travel Nurse - Registered Nurse - TELE - Telemetry - $2033.77 / Week

    Travel Nurse - Registered Nurse - TELE - Telemetry - $2033.77 / Week

    FlexCare • Long Beach, CA, US
    Full-time
    FlexCare is seeking an experienced Telemetry Registered Nurse for an exciting Travel Nursing job in Long Beach, CA.Shift : 3x12 hr nights Start Date : 12 / 15 / 2025 Duration : 13 weeks Pay : $2033.Teachin...Show more
    Last updated: 17 hours ago • Promoted • New!
    Travel Nurse - Registered Nurse - ER - Emergency Room - $2135.68 / Week

    Travel Nurse - Registered Nurse - ER - Emergency Room - $2135.68 / Week

    FlexCare • Long Beach, CA, US
    Full-time
    FlexCare is seeking an experienced Emergency Room Registered Nurse for an exciting Travel Nursing job in Long Beach, CA.Shift : 3x12 hr nights Start Date : 12 / 15 / 2025 Duration : 13 weeks Pay : $2135.Te...Show more
    Last updated: 17 hours ago • Promoted • New!
    Travel Registered Nurse (RN) - Oncology - $2,185 to $2,338 per week in Westlake Village, CA

    Travel Registered Nurse (RN) - Oncology - $2,185 to $2,338 per week in Westlake Village, CA

    TravelNurseSource • Westlake Village, CA, US
    Full-time
    TravelNurseSource is working with Host Healthcare to find a qualified Oncology RN in Westlake Village, California, 91361!. Host Healthcare is an award-winning travel healthcare company with an immed...Show more
    Last updated: 21 days ago • Promoted
    Registered Nurse

    Registered Nurse

    Biolife Plasma Services • LAKEWOOD, CA, US
    Full-time
    By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Tak...Show more
    Last updated: 1 day ago • Promoted
    Travel Nurse - Registered Nurse - LD - Labor and Delivery - $3317.08 / Week

    Travel Nurse - Registered Nurse - LD - Labor and Delivery - $3317.08 / Week

    FlexCare • Harbor City, CA, US
    Full-time
    FlexCare is seeking an experienced Labor and Delivery Registered Nurse for an exciting Travel Nursing job in Harbor City, CA. Shift : 3x12 hr nights Start Date : 11 / 24 / 2025 Duration : 13 weeks Pay : $33...Show more
    Last updated: 13 days ago • Promoted
    Travel Nurse - Registered Nurse - ICU - Intensive Care Unit - $2135.68 / Week

    Travel Nurse - Registered Nurse - ICU - Intensive Care Unit - $2135.68 / Week

    FlexCare • Long Beach, CA, US
    Full-time
    FlexCare is seeking an experienced Intensive Care Unit Registered Nurse for an exciting Travel Nursing job in Long Beach, CA. Shift : 3x12 hr days Start Date : 12 / 15 / 2025 Duration : 13 weeks Pay : $2135...Show more
    Last updated: 17 hours ago • Promoted • New!
    Travel Outpatient Oncology Registered Nurse

    Travel Outpatient Oncology Registered Nurse

    GQR Healthcare • Westlake Village, CA, US
    Full-time
    GQR Healthcare is seeking a travel nurse RN Oncology for a travel nursing job in Westlake Village, California.Job Description & Requirements. Contract - W2 Oncology Registered Nurse (RN) Job.Loc...Show more
    Last updated: 3 days ago • Promoted
    Travel Oncology Registered Nurse

    Travel Oncology Registered Nurse

    Medical Solutions • Westlake Village, CA, US
    Full-time
    Medical Solutions is seeking a travel nurse RN Oncology for a travel nursing job in Westlake Village, California.Job Description & Requirements. We’re seeking talented healthcare professio...Show more
    Last updated: 11 days ago • Promoted
    Travel Outpatient Oncology Registered Nurse

    Travel Outpatient Oncology Registered Nurse

    Stability Healthcare • Westlake Village, CA, US
    Full-time
    Stability Healthcare is seeking a travel nurse RN Oncology for a travel nursing job in Westlake Village, California.Job Description & Requirements. Stability Healthcare is looking for a Oncology...Show more
    Last updated: 30+ days ago • Promoted
    Travel Outpatient Oncology Registered Nurse

    Travel Outpatient Oncology Registered Nurse

    Prime Staffing • Westlake Village, CA, US
    Permanent
    Prime Staffing is seeking a travel nurse RN Oncology for a travel nursing job in Westlake Village, California.Job Description & Requirements. Active State or Compact RN License.Experience with c...Show more
    Last updated: 30+ days ago • Promoted
    Travel CVICU Registered Nurse - $2,685 per week

    Travel CVICU Registered Nurse - $2,685 per week

    MedPro Healthcare Staffing • Tarzana, CA, US
    Full-time
    MedPro Healthcare Staffing is seeking a travel nurse RN CVICU for a travel nursing job in Tarzana, California.Job Description & Requirements. Joint Commission-certified staffing agency, is seeking a...Show more
    Last updated: 9 hours ago • Promoted • New!
    Travel Nurse - Registered Nurse - Oncology - $2265 / Week

    Travel Nurse - Registered Nurse - Oncology - $2265 / Week

    Cynet Health • Fountain Valley, CA, US
    Full-time
    Cynet Health is seeking an experienced Oncology Registered Nurse for an exciting Travel Nursing job in Fountain Valley, CA. Shift : 3x12 hr days Start Date : 12 / 09 / 2025 Duration : 16 weeks Pay : $2265 / ...Show more
    Last updated: 6 days ago • Promoted
    Travel Oncology Registered Nurse

    Travel Oncology Registered Nurse

    GQR Healthcare • Fountain Valley, CA, US
    Full-time
    GQR Healthcare is seeking a travel nurse RN Oncology for a travel nursing job in Fountain Valley, California.Job Description & Requirements. Contract - W2 Oncology Registered Nurse (RN) Job.Loca...Show more
    Last updated: 30+ days ago • Promoted
    Travel Registered Nurse (RN) - Oncology - $2,706 per week in Westlake Village, CA

    Travel Registered Nurse (RN) - Oncology - $2,706 per week in Westlake Village, CA

    TravelNurseSource • Westlake Village, CA, US
    Full-time +1
    TravelNurseSource is working with Lancesoft Inc to find a qualified Oncology RN in Westlake Village, California, 91361!.LOCATION : UCLA Campus Westlake Village Cancer Care (1250 La Venta Drive, Suit...Show more
    Last updated: 21 days ago • Promoted
    Travel Registered Nurse (RN) - Oncology - $2,376 per week in Westlake Village, CA

    Travel Registered Nurse (RN) - Oncology - $2,376 per week in Westlake Village, CA

    TravelNurseSource • Westlake Village, CA, US
    Full-time +1
    TravelNurseSource is working with KPG Healthcare to find a qualified Oncology RN in Westlake Village, California, 91361!. Travel Oncology Registered Nurse - $2,376 per week in taxable pay and non-ta...Show more
    Last updated: 6 days ago • Promoted