Remote Inpatient Medicare Medical Director

Centene
Missouri, Georgia, South Carolina, Florida
Workplace: RemoteFull timeUSD 236,500 - 449,300 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Education: professionalSkills: ["Medical leadership","Quality improvement","Utilization review","Care coordination","Clinical decision-making"]

Lead medical management for inpatient Medicare services by directing and coordinating utilization management, quality improvement, and credentialing activities. Provide medical leadership for cost containment and quality initiatives, perform complex medical reviews, and support performance improvement for capitated providers. Partner with physicians, network providers, appeals, and pharmacy consultants to optimize high-risk patient care, implement recommendations, and represent the business unit in state committees and public forums as needed.

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FursaFursa
Centene
Centene
4 days ago

Remote Inpatient Medicare Medical Director

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Last checked: 3 hours agoStatus: Live

Job Summary

Lead medical management for inpatient Medicare services by directing and coordinating utilization management, quality improvement, and credentialing activities. Provide medical leadership for cost containment and quality initiatives, perform complex medical reviews, and support performance improvement for capitated providers. Partner with physicians, network providers, appeals, and pharmacy consultants to optimize high-risk patient care, implement recommendations, and represent the business unit in state committees and public forums as needed.
Location: Missouri, Georgia, South Carolina, Florida
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Director level

Key Responsibilities

  • •Assist the Chief Medical Director with directing and coordinating medical management, quality improvement, and credentialing functions.
  • •Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
  • •Perform medical review for complex, controversial, or experimental services to support timely and quality decisions.
  • •Support implementation of performance improvement initiatives for capitated providers.
  • •Represent the business unit in state committees and as needed in public forums, and assist physician committees (structure, processes, membership).

Pay and Benefits

Salary: USD 236,500 - 449,300 annually
Equity and Bonus:Equity
Perks:Health Insurance401kPaid 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.
  • •Current state license as a MD or DO without restrictions, limitations, or sanctions.
  • •Actively practices medicine.
  • •Utilization management experience and knowledge of quality accreditation standards preferred.
Education:Professional (JD, MD, etc.)
Skills:Medical leadershipQuality improvementUtilization reviewCare coordinationClinical decision-making
Licenses:Current state license as a MD or DO
Certifications:Board certification (recognized by American Board of Medical Specialists or American Osteopathic Association)American Board Certification in Internal or Family Medicine (preferred)

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