Remote Medical Director, Marketplace

Centene
Missouri, Tennessee, Nebraska, Mississippi, Iowa, Illinois, Kentucky, Minnesota
Workplace: RemoteFull timeUSD 236,500 - 449,300 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Education: professionalSkills: ["Medical leadership","Collaboration","Quality improvement","Medical review","Decision-making"]

Lead medical management for the Marketplace business unit by assisting the Chief Medical Director with utilization management, quality improvement, and credentialing. Conduct medical reviews for complex and controversial services, support performance improvement for capitated providers, and help oversee physician committees. Collaborate with care management, network providers, and appeals teams on high-risk patients and medical necessity decisions, while representing medical philosophy in relevant forums as needed.

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FursaFursa
Centene
Centene
1 month ago

Remote Medical Director, Marketplace

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Source: Company careers pageValidated by: Fursa AI
Last checked: 26 days agoStatus: Live

Job Summary

Lead medical management for the Marketplace business unit by assisting the Chief Medical Director with utilization management, quality improvement, and credentialing. Conduct medical reviews for complex and controversial services, support performance improvement for capitated providers, and help oversee physician committees. Collaborate with care management, network providers, and appeals teams on high-risk patients and medical necessity decisions, while representing medical philosophy in relevant forums as needed.
Location: Missouri, Tennessee, Nebraska, Mississippi, Iowa, Illinois, Kentucky, Minnesota
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Director level

Key Responsibilities

  • •Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing 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 complex/controversial/experimental services to ensure timely decisions.
  • •Support performance improvement initiatives for capitated providers and help establish goals and policies to improve quality and cost-effectiveness.
  • •Conduct rounds for high-risk patients and collaborate with clinical teams, network providers, and appeals teams on medical necessity appeals and complex cases.

Pay and Benefits

Salary: USD 236,500 - 449,300 annually
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Medical Doctor (MD) or Doctor of Osteopathy (DO).
  • •Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association.
  • •Current state license as an MD or DO without restrictions, limitations, or sanctions from government programs.
  • •Utilization Management experience and knowledge of quality accreditation standards preferred.
  • •Certification in Internal or Family Medicine, preferred.
Experience:Utilization managementHealthcare
Education:Professional (JD, MD, etc.)
Skills:Medical leadershipCollaborationQuality improvementMedical reviewDecision-making
Licenses:Current state MD/DO license
Certifications:Board certificationInternal MedicineFamily Medicine

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