Remote Medical Director, Inpatient Medicare

Overview

The Remote Medical Director will lead medical management and quality improvement initiatives for Centene, ensuring effective utilization management and compliance with healthcare regulations.

In Short

• Direct and coordinate medical management and quality improvement functions.
• Perform medical review activities for utilization and quality assurance.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams and network providers.
• Assist in physician education regarding clinical issues and policies.
• Identify and evaluate trends in utilization of medical services.
• Review complex medical claims for necessity and appropriate payment.
• Develop alliances with the provider community.
• Represent the business unit at state committees.
• May require working weekends and holidays.

Requirements

• Medical Doctor or Doctor of Osteopathy required.
• Utilization Management experience preferred.
• Active medical practice required.
• Coursework in Health Administration or related fields is advantageous.
• Experience with culturally diverse populations preferred.
• Board certification in Internal Medicine or Family Medicine required.
• Current state medical license without restrictions.

Benefits

• Competitive pay and health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement and paid time off.
• Flexible work schedules including remote options.
• Commitment to diversity and equal opportunity.