Pediatrics Medical Director – Florida (3 Days Left) Position Available In Duval, Florida

Job Description:

You could be the one who changes everything for our 28 millionmembers as a clinical professional on our Medical Management/HealthServices team. Centene is a diversified, national organizationoffering competitive benefits including a fresh perspective onworkplace flexibility.

Position Purpose:

Assist the Chief MedicalDirector to direct and coordinate the medical management, qualityimprovement and credentialing functions for the business unit. Mustreside in Florida.

• Provides medical leadership of all forutilization management, cost containment, and medical qualityimprovement activities.
• Performs medical review activitiespertaining to utilization review, quality assurance, and medicalreview of complex, controversial, or experimental medical services,ensuring timely and quality decision making.
• Supports effectiveimplementation of performance improvement initiatives for capitatedproviders.
• Assists Chief Medical Director in planning andestablishing goals and policies to improve quality andcost-effectiveness of care and service for members.
• Providesmedical expertise in the operation of approved quality improvementand utilization management programs in accordance with regulatory,state, corporate, and accreditation requirements.
• Assists theChief Medical Director in the functioning of the physiciancommittees including committee structure, processes, andmembership.
• Conduct regular rounds to assess and coordinate carefor high-risk patients, collaborating with care management teams tooptimize outcomes.
• Collaborates effectively with clinical teams,network providers, appeals team, medical and pharmacy consultantsfor reviewing complex cases and medical necessity appeals.
• Participates in provider network development and new marketexpansion as appropriate.
• Assists in the development andimplementation of physician education with respect to clinicalissues and policies.
• Identifies utilization review studies andevaluates adverse trends in utilization of medical services,unusual provider practice patterns, and adequacy of benefit/paymentcomponents.
• Identifies clinical quality improvement studies toassist in reducing unwarranted variation in clinical practice inorder to improve the quality and cost of care.
• Interfaces withphysicians and other providers in order to facilitateimplementation of recommendations to providers that would improveutilization and health care quality.
• Reviews claims involvingcomplex, controversial, or unusual or new services in order todetermine medical necessity and appropriate payment.
• Developsalliances with the provider community through the development andimplementation of the medical management programs.
• As needed, mayrepresent the business unit before various publics both locally andnationally on medical philosophy, policies, and related issues.
• Represents the business unit at appropriate state committees andother ad hoc committees.
• May be required to work weekends andholidays in support of business operations, as needed.

Education/Experience:

Medical Doctor or Doctor of Osteopathy.

Utilization Management experience and knowledge of qualityaccreditation standards preferred. Actively practices medicine.

Course work in the areas of Health Administration, HealthFinancing, Insurance, and/or Personnel Management is advantageous.

Experience treating or managing care for a culturally diversepopulation preferred.

License/Certifications:

Board certificationin a medical specialty recognized by the American Board of MedicalSpecialists or the American Osteopathic Association’s Department ofCertifying Board Services. Current Florida state license as a MD orDO without restrictions, limitations, or sanctions from governmentprograms.

Pay Range:

$231,900.00

• $440,500.

00 per year Centeneoffers a comprehensive benefits package including: competitive pay,health insurance, 401K and stock purchase plans, tuitionreimbursement, paid time off plus holidays, and a flexible approachto work with remote, hybrid, field or office work schedules. Actualpay 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 mayalso include additional forms of incentives. Benefits may besubject to program eligibility. Centene is an equal opportunityemployer that is committed to diversity, and values the ways inwhich we are different. All qualified applicants will receiveconsideration for employment without regard to race, color,religion, sex, sexual orientation, gender identity, nationalorigin, disability, veteran status, or other characteristicprotected by applicable law. Qualified applicants with arrest orconviction records will be considered in accordance with the LACounty Ordinance and the California Fair Chance Act