Remote National Medical Director

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team

Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility

Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities

Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making

Supports effective implementation of performance improvement initiatives for capitated providers

Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members

Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements

Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership

Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes

Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals