(High Salary) Part-time Pediatric / Family Medicine Medical Director – Florida Position Available In Miami-Dade, 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. Thisrole is remote, but must be a Florida resident.

• Provides medicalleadership of all for utilization management, cost containment, andmedical quality improvement activities.
• Performs medical reviewactivities pertaining to utilization review, quality assurance, andmedical review of complex, controversial, or experimental medicalservices, ensuring timely and quality decision making.
• Supportseffective implementation of performance improvement initiatives forcapitated providers.
• Assists Chief Medical Director in planningand establishing 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. (Pediatrician and/or Family Medicinepreferred.) Current Florida state license as a MD or DO withoutrestrictions, limitations, or sanctions from government programs.

Pay Range:

$231,900.00

• $440,500.

00 per year Centene offers acomprehensive benefits package including: competitive pay, healthinsurance, 401K and stock purchase plans, tuition reimbursement,paid time off plus holidays, and a flexible approach to work withremote, hybrid, field or office work schedules. Actual pay will beadjusted based on an individual’s skills, experience, education,and other job-related factors permitted by law. Total compensationmay also include additional forms of incentives. Centene is anequal opportunity employer that is committed to diversity, andvalues the ways in which we are different. All qualified applicantswill receive consideration 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