Centene

3 weeks ago

Supervisory Medical Director, National Physical Health Appeals Outpatient UM

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 4 hours agoStatus: Live

Job Summary

Provide medical and leadership expertise to ensure high-quality, cost-effective care for members within Medical Management/Health Services. Lead and mentor a team of front-line medical directors, oversee utilization management coverage, and support utilization review studies, performance management, and trend analysis. Manage complex UM cases and appeals in compliance with regulatory requirements, conduct case escalation reviews, and deliver clinical guidance and training on regulatory updates.

Location: Missouri, Kansas, Arizona, New York, North Carolina, Texas, California

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Director level

Key Responsibilities

•Provide operational leadership, coaching, and mentorship for a team of front-line medical directors, including scheduling for utilization management coverage and performance goal development.
•Participate in creation and updates to new hire and existing medical director training, including new hire mentorship.
•Support the Chief Medical Officer and Senior Medical Director in execution of strategic clinical initiatives and oversight of utilization review studies.
•Handle complex and high-profile utilization management cases, ensuring timely and appropriate decision-making.
•Oversee and participate in the appeals process and case escalation reviews in collaboration with healthcare providers and market leadership, ensuring regulatory compliance.

Pay and Benefits

Salary: USD 236,500 - 449,300 annually

Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

•MD graduate of an accredited medical school required.
•5+ years managed care/clinical experience with commercial, Medicare, and Medicaid lines of business required.
•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 required.
•Current state medical license as an MD or DO without restrictions, limitations, or sanctions from government programs required.
•1+ years supervisory/management experience preferred, with Internal or Family Medicine board certification preferred.

Experience:5+ yearsManaged careClinical experienceMedicareMedicaidUtilization management

Education:Professional (JD, MD, etc.)

Skills:LeadershipCoachingMentorshipCase managementCollaboration

Licenses:State medical licensure (MD or DO)

Certifications:Board certification (recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services)

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

Website LinkedIn

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Centene

3 weeks ago

Supervisory Medical Director, National Physical Health Appeals Outpatient UM

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 4 hours agoStatus: Live

Job Summary

Location: Missouri, Kansas, Arizona, New York, North Carolina, Texas, California

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Director level

Key Responsibilities

•Provide operational leadership, coaching, and mentorship for a team of front-line medical directors, including scheduling for utilization management coverage and performance goal development.
•Participate in creation and updates to new hire and existing medical director training, including new hire mentorship.
•Support the Chief Medical Officer and Senior Medical Director in execution of strategic clinical initiatives and oversight of utilization review studies.
•Handle complex and high-profile utilization management cases, ensuring timely and appropriate decision-making.
•Oversee and participate in the appeals process and case escalation reviews in collaboration with healthcare providers and market leadership, ensuring regulatory compliance.

Pay and Benefits

Salary: USD 236,500 - 449,300 annually

Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

•MD graduate of an accredited medical school required.
•5+ years managed care/clinical experience with commercial, Medicare, and Medicaid lines of business required.
•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 required.
•Current state medical license as an MD or DO without restrictions, limitations, or sanctions from government programs required.
•1+ years supervisory/management experience preferred, with Internal or Family Medicine board certification preferred.

Experience:5+ yearsManaged careClinical experienceMedicareMedicaidUtilization management

Education:Professional (JD, MD, etc.)

Skills:LeadershipCoachingMentorshipCase managementCollaboration

Licenses:State medical licensure (MD or DO)

Certifications:Board certification (recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services)

Company Brief

Centene

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

Website LinkedIn