Join Centene in our mission to transform the health of communities, impacting the lives of over 28 million members. As a key Executive on our team, you have the opportunity to make a significant difference.
Position Purpose : In this role, you will provide essential medical oversight, expertise, and leadership to ensure the delivery of quality healthcare services while maintaining cost-effectiveness for health plan members.
- Act as a clinical advisor and educator for medical management staff, ensuring accurate clinical judgment is applied in all medical management determinations.
- Lead the development, implementation, and interpretation of medical review and quality-related policies and guidelines.
- Provide oversight and direction for staff education and training, fostering a culture of continuous improvement.
- Build positive relationships with the local medical community, including regular consultations with providers and prescribers.
- Analyze case management data to identify trends and gaps in care, recommending actionable improvements.
- Oversee issues related to quality of care, developing and implementing protocols to enhance service delivery.
- Monitor performance metrics to ensure care is both cost-effective and meets high-quality standards.
- Assess member and provider satisfaction levels, proposing and executing strategies for enhancement.
- Collaborate to establish corporate clinical care standards and medical practice policies.
- Provide medical guidance to the Medical Management department to enhance operational effectiveness.
Education / Experience :
Medical Doctor (MD) or Doctor of Osteopathy (DO) is required.Minimum of 7 years of clinical experience in the practice of medicine is required.Management experience is preferred.Knowledge of Utilization Management and quality accreditation standards is preferred.Active medical practice and engagement in the local medical community is preferred.Coursework in Health Administration, Health Financing, Insurance, and / or Personnel Management is preferred.Experience with managing care for culturally diverse populations is preferred.Licenses / Certifications :
Board certification in a medical specialty recognized by the American Board of Medical Specialists is required.Certification in a primary care specialty is preferred.Must possess a current, unrestricted Texas state license as an MD or DO, free of limitations or sanctions from government programs.Note : For Superior HealthPlan, residence in Texas is required.
The pay range for this role is $271,000.00 - $515,500.00 annually. Centene offers a comprehensive benefits package, including competitive salary, health insurance, 401K, stock purchase plans, tuition reimbursement, and flexible work arrangements. Total compensation is subject to adjustment based on qualifications and experience, and may include additional incentives.
Centene is dedicated to promoting diversity and is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any protected characteristic.
We encourage applicants of all backgrounds to apply.