? High Salary: Remote Medical Director – South Carolina Position Available In Charleston, South Carolina

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.

• Provides medical leadership of all for utilization management, costcontainment, and medical quality improvement activities.
• Performsmedical review activities pertaining to utilization review, qualityassurance, and medical review of complex, controversial, orexperimental medical services, ensuring timely and quality decisionmaking.
• Supports effective implementation of performanceimprovement initiatives for capitated providers.
• Assists ChiefMedical Director in planning and establishing goals and policies toimprove quality and cost-effectiveness of care and service formembers.
• Provides medical expertise in the operation of approvedquality improvement and utilization management programs inaccordance with regulatory, state, corporate, and accreditationrequirements.
• Assists the Chief Medical Director in thefunctioning of the physician committees including committeestructure, processes, and membership.
• Conduct regular rounds toassess and coordinate care for high-risk patients, collaboratingwith care management teams to optimize outcomes.
• Collaborateseffectively with clinical teams, network providers, appeals team,medical and pharmacy consultants for reviewing complex cases andmedical necessity appeals.
• Participates in provider networkdevelopment and new market expansion as appropriate.
• Assists inthe development and implementation of physician education withrespect to clinical issues and policies.
• Identifies utilizationreview studies and evaluates adverse trends in utilization ofmedical services, unusual provider practice patterns, and adequacyof benefit/payment components.
• Identifies clinical qualityimprovement studies to assist in reducing unwarranted variation inclinical practice in order to improve the quality and cost of care
• Interfaces with physicians and other providers in order tofacilitate implementation of recommendations to providers thatwould improve utilization and health care quality.
• Reviews claimsinvolving complex, controversial, or unusual or new services inorder to determine medical necessity and appropriate payment.
• Develops alliances with the provider community through thedevelopment and implementation of the medical management programs
• As needed, may represent the business unit before various publicsboth locally and nationally on medical philosophy, policies, andrelated issues.
• Represents the business unit at appropriate statecommittees and other ad hoc committees.
• May be required to workweekends and holidays 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 South Carolina state license asa MD or DO without restrictions, limitations, or sanctions fromgovernment programs.

Pay Range:

$221,300.00

• $420,500.

00 per yearCentene offers a comprehensive benefits package including:competitive pay, health insurance, 401K and stock purchase plans,tuition reimbursement, paid time off plus holidays, and a flexibleapproach to work with remote, hybrid, field or office workschedules. Actual pay will be adjusted based on an individual’sskills, experience, education, and other job-related factorspermitted by law. Total compensation may also include additionalforms of incentives. Centene is an equal opportunity employer thatis committed to diversity, and values the ways in which we aredifferent. All qualified applicants will receive consideration foremployment without regard to race, color, religion, sex, sexualorientation, gender identity, national origin, disability, veteranstatus, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will beconsidered in accordance with the LA County Ordinance and theCalifornia Fair Chance Act