Remote Behavioral Medical Director, Central Region

Centene
Missouri, Nebraska, Kansas, Iowa, Texas, Illinois, Oklahoma
Workplace: RemoteFull timeUSD 236,500 - 449,300 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Skills: ["Medical leadership","Quality improvement","Utilization management","Care coordination","Collaboration"]

Lead medical management for a behavioral health business unit by assisting the Chief Medical Director with utilization management, cost containment, quality improvement, and credentialing. Conduct medical reviews for complex and experimental services, support performance improvement for capitated providers, and help establish goals, physician committees, and physician education. Coordinate care for high-risk patients, collaborate across clinical teams and providers, and represent the unit on medical philosophy and policy at state and ad hoc committees.

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FursaFursa
Centene
Centene
1 month ago

Remote Behavioral Medical Director, Central Region

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Last checked: 16 days agoStatus: Live

Job Summary

Lead medical management for a behavioral health business unit by assisting the Chief Medical Director with utilization management, cost containment, quality improvement, and credentialing. Conduct medical reviews for complex and experimental services, support performance improvement for capitated providers, and help establish goals, physician committees, and physician education. Coordinate care for high-risk patients, collaborate across clinical teams and providers, and represent the unit on medical philosophy and policy at state and ad hoc committees.
Location: Missouri, Nebraska, Kansas, Iowa, Texas, Illinois, Oklahoma
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 for the business unit.
  • •Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
  • •Perform medical review activities for utilization review, quality assurance, and medical review of complex or experimental services, ensuring timely and quality decisions.
  • •Support implementation of 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, appeals teams, and medical/pharmacy consultants to review complex cases and medical necessity appeals.

Pay and Benefits

Salary: USD 236,500 - 449,300 annually
Perks:Health Insurance401kEquityPaid LeavePaid HolidaysRemote Work

Key Requirements

  • •Medical Doctor (MD) or Doctor of Osteopathy (DO), actively practices medicine.
  • •Board certification by the American Board of Psychiatry and Neurology.
  • •Current state license as an MD or DO without restrictions, limitations, or sanctions.
  • •Utilization management experience and knowledge of quality accreditation standards preferred.
  • •Experience treating or managing care for a culturally diverse population preferred.
Skills:Medical leadershipQuality improvementUtilization managementCare coordinationCollaboration
Licenses:Current state license as a MD or DO
Certifications:Board certification by the American Board of Psychiatry and NeurologyCertification in Child Psychiatry

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