Full-Time

Medical Director

Confirmed live in the last 24 hours

Centene

Centene

10,001+ employees

Provides health insurance and services

Healthcare

Compensation Overview

$206.7k - $392.6kAnnually

+ Incentives

Senior, Expert

Remote in USA

Candidates must be based in Washington state.

Category
Physicians & Surgeons
Medical, Clinical & Veterinary

You match the following Centene's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Medical Doctor or Doctor of Osteopathy
  • 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 Washington state license as a MD or DO without restrictions, limitations, or sanctions from government programs
  • 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
Responsibilities
  • 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
Desired Qualifications
  • Utilization Management experience and knowledge of quality accreditation standards preferred
  • Experience treating or managing care for a culturally diverse population preferred

Centene Corporation provides health insurance and services primarily to underinsured and uninsured individuals in the United States. The company offers a range of products, including medical, dental, vision, and behavioral health services, using a localized approach to meet community needs. Centene stands out from competitors by focusing on cost-effective, high-quality care and addressing social barriers to health. Its goal is to improve health outcomes while ensuring employee well-being and corporate sustainability.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Centene's membership increased by 12% in Marketplace and 50% in Medicare PDP in 2024.
  • The expansion of low-cost plans like Fidelis Care's Essential Plan increases healthcare accessibility.
  • Centene's ICHRA plans offer customizable and transparent health insurance options.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may pressure Centene's market share.
  • Reliance on government contracts exposes Centene to political and policy changes.
  • Natural disasters and new health threats could strain Centene's operational capabilities.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company offers a wide range of health insurance products through local brands.
  • Centene focuses on cost-effective, high-quality care for underinsured and uninsured individuals.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours