Remote Medical Director, Inpatient Marketplace

About the role

Centene is hiring a Remote Medical Director for its Inpatient Marketplace business unit. The role assists the Chief Medical Director in directing and coordinating medical management, quality improvement and credentialing, and provides medical leadership of utilization management, cost containment and quality improvement activities. The position is remote.

Key responsibilities

• Perform medical review of utilization, quality assurance and complex, controversial or experimental services, ensuring timely decisions.
• Support performance improvement initiatives for capitated providers and help plan goals and policies to improve quality and cost-effectiveness of care.
• Operate approved quality improvement and utilization management programs in line with regulatory, state, corporate and accreditation requirements.
• Help run physician committees, including their structure, processes and membership.
• Conduct regular rounds for high-risk patients and collaborate with care management teams.
• Review complex cases and medical necessity appeals with clinical teams, network providers, appeals teams, medical and pharmacy consultants.
• Take part in provider network development, new market expansion and physician education on clinical issues and policies.
• Identify utilization review studies, adverse trends, unusual provider patterns and gaps in benefits or payment, and quality improvement studies to reduce unwarranted variation in practice.
• Interface with providers to implement recommendations, review claims for medical necessity and payment, and build alliances with the provider community.
• Represent the business unit before local and national publics and at state committees on medical philosophy and policy; weekends and holidays may be required.

Required profile

• Medical Doctor (MD) or Doctor of Osteopathy (DO); actively practicing medicine.
• Board certification in a specialty recognized by the ABMS or the American Osteopathic Association; Internal or Family Medicine certification preferred.
• Current unrestricted state license as MD or DO.
• Utilization management experience and knowledge of quality accreditation standards preferred; health administration, health financing, insurance and personnel management coursework advantageous; experience with culturally diverse populations preferred.

What we offer

• Pay range of $215,000 to $408,500 per year, adjusted for skills, experience and other factors.
• Health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays.
• Flexible schedule: remote, hybrid, field or office work.