Remote Medical Director, Inpatient Medicare

Centene
Missouri, New Mexico, Arizona, Utah, Washington, Oregon, Colorado, California
Workplace: RemoteFull timeUSD 236,500 - 449,300 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Education: professionalSkills: []

Lead medical management for inpatient Medicare programs by coordinating quality improvement, credentialing, utilization management, and cost containment for a business unit. Provide medical leadership for utilization review and medical review decisions involving complex or experimental services, support performance improvement initiatives for capitated providers, and partner with clinical, network, and pharmacy consultants to resolve medical necessity appeals. Represent the business unit in committees and may conduct rounds for high-risk patients.

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Centene
Centene
4 days ago

Remote Medical Director, Inpatient Medicare

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Job Summary

Lead medical management for inpatient Medicare programs by coordinating quality improvement, credentialing, utilization management, and cost containment for a business unit. Provide medical leadership for utilization review and medical review decisions involving complex or experimental services, support performance improvement initiatives for capitated providers, and partner with clinical, network, and pharmacy consultants to resolve medical necessity appeals. Represent the business unit in committees and may conduct rounds for high-risk patients.
Location: Missouri, New Mexico, Arizona, Utah, Washington, Oregon, Colorado, California
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.
  • •Conduct medical review activities for utilization review, quality assurance, and complex/controversial/experimental medical services to ensure timely decision-making.
  • •Support implementation of performance improvement initiatives for capitated providers and help plan goals and policies to improve quality and cost-effectiveness of care.
  • •Collaborate with clinical teams, network providers, appeals teams, and consultants on complex cases and medical necessity appeals; represent the business unit in committees as appropriate.

Pay and Benefits

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

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.
  • •Active American Board Certification in Internal Medicine or Family Medicine (preferred).
  • •Current state medical license as MD or DO without restrictions, limitations, or sanctions.
  • •Utilization Management experience and knowledge of quality accreditation standards (preferred).
Education:Professional (JD, MD, etc.)
Licenses:Current state license as a MD or DO without restrictions, limitations, or sanctions
Certifications:Board certificationAmerican Board Certification (Internal Medicine or Family 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