Job Description

Remote Medical Director - South Carolina

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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 offers competitive benefits and flexible workplace options.

Position Purpose:

Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit.

Responsibilities:

1. Provide medical leadership for utilization management, cost containment, and quality improvement activities.
2. Perform medical reviews related to utilization review, quality assurance, and complex or controversial medical services, ensuring timely decisions.
3. Support performance improvement initiatives for capitated providers.
4. Help establish goals and policies to improve quality and cost-effectiveness of care.
5. Ensure compliance with regulatory, state, corporate, and accreditation standards in quality and utilization management programs.
6. Assist in physician committee operations, including structure, processes, and membership.
7. Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care teams.
8. Work with clinical teams, providers, and consultants on complex cases and appeals.
9. Participate in provider network development and market expansion.
10. Contribute to physician education on clinical issues and policies.
11. Identify utilization trends and clinical quality improvement opportunities.
12. Facilitate implementation of recommendations to providers to enhance utilization and quality.
13. Review claims involving complex or unusual services for medical necessity and payment accuracy.
14. Develop alliances with providers through medical management programs.
15. Represent the business unit at state and national forums on medical policies and issues.
16. Support operational needs, including working weekends and holidays if necessary.

Qualifications:

Medical Doctor or Doctor of Osteopathy with active practice. Utilization Management experience and knowledge of accreditation standards preferred. Coursework in health administration, financing, insurance, or personnel management is advantageous. Experience with diverse populations is preferred.

Licenses/Certifications:

Board certification in a recognized medical specialty. Valid South Carolina MD or DO license without restrictions or sanctions.

Additional Details:

Pay Range: $221,300 - $420,500 annually.

Benefits include competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements.

Centene is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will be considered without regard to protected characteristics.

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