? [15h Left] Remote Marketplace Medical Director Position Available In St. Louis, Missouri

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.

Those able to work MST or PST hours, preferred

• 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.

Education/Experience:

Medical Doctor orDoctor of Osteopathy. Utilization Management experience andknowledge of quality accreditation standards preferred. Activelypractices medicine. Course work in the areas of HealthAdministration, Health Financing, Insurance, and/or PersonnelManagement is advantageous. Experience treating or managing carefor a culturally diverse population preferred.

License/Certifications:

Board certification in a medical specialtyrecognized by the American Board of Medical Specialists or theAmerican Osteopathic Association’s Department of Certifying BoardServices. Current 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 comprehensivebenefits package including: competitive pay, health insurance, 401Kand stock purchase plans, tuition reimbursement, paid time off plusholidays, and a flexible approach to work with remote, hybrid,field or office work schedules. Actual pay will be adjusted basedon an individual’s skills, experience, education, and otherjob-related factors permitted by law. Total compensation may alsoinclude additional forms of incentives. Centene is an equalopportunity employer that is committed to diversity, and values theways in which we are different. All qualified applicants willreceive 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