Medical Director

Centene
New Hampshire
Workplace: RemoteFull timeUSD 215,000 - 408,500 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Education: professionalSkills: ["Medical leadership","Collaboration","Clinical decision-making","Quality improvement","Utilization management"]

Lead clinical medical management for a health plan, supporting the Chief Medical Director with utilization management, cost containment, and medical quality improvement. Conduct medical reviews for complex or experimental services, coordinate care for high-risk patients, and help implement performance improvement initiatives for capitated providers. Collaborate with clinical teams, network providers, appeals, and consultants, and support physician committee functions and provider education. Ensure decisions meet regulatory and accreditation requirements.

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FursaFursa
Centene
Centene
1 month ago

Medical Director

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Source: Company careers pageValidated by: Fursa AI
Last checked: 27 days agoStatus: Live

Job Summary

Lead clinical medical management for a health plan, supporting the Chief Medical Director with utilization management, cost containment, and medical quality improvement. Conduct medical reviews for complex or experimental services, coordinate care for high-risk patients, and help implement performance improvement initiatives for capitated providers. Collaborate with clinical teams, network providers, appeals, and consultants, and support physician committee functions and provider education. Ensure decisions meet regulatory and accreditation requirements.
Location: New Hampshire
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Director level

Key Responsibilities

  • •Assist the Chief Medical Director to direct and coordinate medical management, quality improvement, and credentialing functions for the business unit.
  • •Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
  • •Perform medical review for utilization review, quality assurance, and medical review of complex, controversial, or experimental services to support timely decisions.
  • •Support implementation of performance improvement initiatives for capitated providers and help set goals and policies to improve quality and cost-effectiveness of care.
  • •Assist with physician committees and collaborate with clinical teams, network providers, appeals teams, and medical/pharmacy consultants for complex cases and medical necessity appeals.

Pay and Benefits

Salary: USD 215,000 - 408,500 annually
Perks:Health Insurance401kEquity

Key Requirements

  • •MD or DO without restrictions
  • •Board Certified Physician
  • •Current New Hampshire state license as a MD or DO without restrictions, limitations, or sanctions from government programs
  • •Actively practices medicine or has been an actively practicing physician within the last 5 years
  • •Utilization Management experience and knowledge of quality accreditation standards preferred
Education:Professional (JD, MD, etc.)
Skills:Medical leadershipCollaborationClinical decision-makingQuality improvementUtilization management
Licenses:New Hampshire state license (MD or DO)
Certifications:Board certification in a medical specialty

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn