Talent.com
Remote Medical Director - Missouri - Ohio - Kansas
Remote Medical Director - Missouri - Ohio - KansasCentene Corporation • Nelson, WI, US
serp_jobs.error_messages.no_longer_accepting
Remote Medical Director - Missouri - Ohio - Kansas

Remote Medical Director - Missouri - Ohio - Kansas

Centene Corporation • Nelson, WI, US
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.job_card.part_time
  • serp_jobs.filters.remote
job_description.job_card.job_description

Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

We’re Hiring : Full time Medical Directors

Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace.

Looking for a compelling opportunity to move beyond patient encounters and drive meaningful change in the community?

Qualifications for this role include :

  • MD or DO without restriction
  • Board certified in Internal Medicine or Family Medicine
  • Utilization Management experience and knowledge of quality accreditation standards.
  • Actively practices medicine

Position Purpose :

Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
  • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.
  • Supports effective implementation of performance improvement initiatives for capitated providers.
  • Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
  • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
  • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
  • Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
  • Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
  • Participates in provider network development and new market expansion as appropriate.
  • Assists in the development and implementation of physician education with respect to clinical issues and policies.
  • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit / payment components.
  • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
  • Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
  • Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
  • Develops alliances with the provider community through the development and implementation of the medical management programs.
  • As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
  • Represents the business unit at appropriate state committees and other ad hoc committees.
  • May be required to work weekends and holidays in support of business operations, as needed.
  • Education / Experience :

    Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and / or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred.

    License / Certifications : Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.

    Current state license (Kansas-Ohio-Michigan-Wisconsin-Illinois-Nebraska-Iowa-Missouri-Pennsylvania-Indiana preferred) as a MD or DO without restrictions, limitations, or sanctions from government programs.

    Pay Range : $221,300.00 - $420,500.00 per year

    Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay 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 may also include additional forms of incentives. Benefits may be subject to program eligibility.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

    Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

    serp_jobs.job_alerts.create_a_job

    Medical Director • Nelson, WI, US

    Job_description.internal_linking.related_jobs
    Travel MRI Technologist

    Travel MRI Technologist

    Nightingale Nurses • Rochester, MN, US
    serp_jobs.job_card.full_time
    Nightingale Nurses is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. You may not realize it, but as an RN with real world hospital exp...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    RN Clinical Reimbursement / MDS Manager

    RN Clinical Reimbursement / MDS Manager

    Benedictine • Winona, MN, United States
    serp_jobs.job_card.full_time
    RN Clinical Reimbursement / MDS Manager.Benedictine Living Community-Winona.Are you ready to make a difference.As the RN -Clinical Reimbursement Coordinator you will be empowered to use the nursing s...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Director of Nursing Needed in Arkansaw, WI

    Director of Nursing Needed in Arkansaw, WI

    Gpac • Arkansaw, Wisconsin, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Are you a compassionate, visionary nurse leader ready to make a meaningful impact? We’re seeking a .Proudly recognized as one of the . DON who shares our passion for serving seniors ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Director of Nursing Needed in Maiden Rock, WI

    Director of Nursing Needed in Maiden Rock, WI

    Gpac • Maiden Rock, Wisconsin, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Are you a compassionate, visionary nurse leader ready to make a meaningful impact? We’re seeking a .Proudly recognized as one of the . DON who shares our passion for serving seniors ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Travel MRI Technologist - $3,359 per week

    Travel MRI Technologist - $3,359 per week

    American Traveler • Rochester, MN, United States
    serp_jobs.job_card.full_time
    American Traveler is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements Specialty : MRI Technologist Discipline : Allied Health Professional ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Director of Nursing Needed in Plum City, WI

    Director of Nursing Needed in Plum City, WI

    Gpac • Plum City, Wisconsin, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Are you a compassionate, visionary nurse leader ready to make a meaningful impact? We’re seeking a .Proudly recognized as one of the . DON who shares our passion for serving seniors ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Travel MRI Technologist

    Travel MRI Technologist

    Medical Solutions Allied • Rochester, MN, US
    serp_jobs.job_card.full_time
    Medical Solutions Allied is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. We’re seeking talented healthcare professionals whose...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel MRI Technologist - $3,389 per week

    Travel MRI Technologist - $3,389 per week

    The Judge Group • Rochester, MN, United States
    serp_jobs.job_card.full_time
    The Judge Group is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. Won't have specific shift hours until the time of offer.The shifts would...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel MRI Technologist - $3,045 per week

    Travel MRI Technologist - $3,045 per week

    Host Healthcare • Rochester, MN, US
    serp_jobs.job_card.full_time
    Host Healthcare is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements Specialty : MRI Technologist Discipline : Allied Health Professional Start...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel MRI Technologist - $2,850 per week

    Travel MRI Technologist - $2,850 per week

    Siemens Healthineers • Rochester, MN, US
    serp_jobs.job_card.full_time
    Siemens Healthineers is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. Siemens Healthineers currently seeking candidates for.This is a...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Director of Nursing Needed in Durand, WI

    Director of Nursing Needed in Durand, WI

    Gpac • Durand, Wisconsin, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Are you a compassionate, visionary nurse leader ready to make a meaningful impact? We’re seeking a .Proudly recognized as one of the . DON who shares our passion for serving seniors ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Travel Magnetic Resonance Technologist

    Travel Magnetic Resonance Technologist

    Nightingale Nurses • Rochester, MN, US
    serp_jobs.job_card.full_time
    Nightingale Nurses is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. You may not realize it, but as an RN with real world hospital exp...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Histotech Assistant

    Histotech Assistant

    Mayo Clinic • Rochester, MN, US
    serp_jobs.job_card.full_time
    Mayo Clinic is top-ranked in more specialties than any other care provider according to U.As we work together to put the needs of the patient first, we are also dedicated to our employees, investin...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel MRI Technologist

    Travel MRI Technologist

    IDR Healthcare • Rochester, MN, US
    serp_jobs.job_card.full_time
    IDR Healthcare is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. IDR Healthcare is an awarding winning staffing firm that believes it ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel MRI Technologist - $3,123 per week

    Travel MRI Technologist - $3,123 per week

    Triage Staffing • Rochester, MN, United States
    serp_jobs.job_card.full_time
    Triage Staffing is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. Travel Radiology : MRI Tech Rochester, MN.Location : Rochester, MN...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Magnetic Resonance Technologist - $3,084 per week

    Travel Magnetic Resonance Technologist - $3,084 per week

    Nightingale Nurses • Rochester, MN, US
    serp_jobs.job_card.full_time
    Nightingale Nurses is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements. You may not realize it, but as an RN with real world hospital exp...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Assistant Regional Director

    Assistant Regional Director

    New Season • ROCHESTER, MN, US
    serp_jobs.job_card.full_time +1
    Provides support, oversight, and guidance to Regional and Program Directors to ensure clinic growth and the overall well-being and safety of patients. Works with Program Directors, Program Medical D...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Travel MRI Technologist - $3,056 per week

    Travel MRI Technologist - $3,056 per week

    Aequor Allied • Rochester, MN, United States
    serp_jobs.job_card.full_time
    Aequor Allied is seeking a travel MRI Technologist for a travel job in Rochester, Minnesota.Job Description & Requirements Specialty : MRI Technologist Discipline : Allied Health Professional ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Program Director

    Program Director

    New Season • Rochester, MN, United States
    serp_jobs.job_card.full_time
    Description New Season : For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, q...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Resident Services Director

    Resident Services Director

    SilverCrest • Rochester, MN, US
    serp_jobs.job_card.full_time
    Director Of Resident Services At Shorewood, An Assisted Living Community.Start a new career as a Director of Resident Services at Shorewood, an Assisted Living Community! Make a difference in someo...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted