Remote Behavioral Medical Director
Company: Centene
Location: Oklahoma City
Posted on: November 20, 2023
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Job Description:
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. 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. Oversees the activities of physician
advisors. Utilizes the services of medical and pharmacy consultants
for reviewing complex cases and medical necessity appeals.
Participates in provider network development and new market
expansion as appropriate. Assists in the development and
implementation of physician education with respect to clinical
issues and policies. Identifies utilization review studies and
evaluates adverse trends in utilization of medical services,
unusual provider practice patterns, and adequacy of benefit/payment
components. Identifies clinical quality improvement studies to
assist in reducing unwarranted variation in clinical practice in
order to improve the quality and cost of care. Interfaces with
physicians and other providers in order to facilitate
implementation of recommendations to providers that would improve
utilization and health care quality. Reviews claims involving
complex, controversial, or unusual or new services in order to
determine medical necessity and appropriate payment. Develops
alliances with the provider community through the development and
implementation of the medical management programs. As needed, may
represent the business unit before various publics both locally and
nationally on medical philosophy, policies, and related issues.
Represents the business unit at appropriate state committees and
other ad hoc committees Education/Experience: Medical Doctor or
Doctor of Osteopathy. 7 years of clinical experience in the
practice of medicine. Utilization Management experience and
knowledge of quality accreditation standards preferred. Actively
practices medicine. Course work in the areas of Health
Administration, Health Financing, Insurance, and/or Personnel
Management is advantageous. Experience treating or managing care
for a culturally diverse population preferred.
License/Certifications: For Behavioral Health only - Board
certification by the American Board of Psychiatry and Neurology.
Current Oklahoma state (or ability to obtain one) medical license
without restrictions. Our Comprehensive Benefits Package: Flexible
work solutions including remote options, hybrid work schedules and
dress flexibility, Competitive pay, Paid time off including
holidays, Health insurance coverage for you and your dependents,
401(k) and stock purchase plans, Tuition reimbursement and
best-in-class training and development. Centene is an equal
opportunity employer that is committed to diversity, and values the
ways in which we are different. All qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex, sexual orientation, gender identity, national
origin, disability, veteran status, or other characteristic
protected by applicable law.
Keywords: Centene, Oklahoma City , Remote Behavioral Medical Director, Executive , Oklahoma City, Oklahoma
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