What are the responsibilities and job description for the Medical Director position at Coordinated Care?
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:
- Provide medical leadership of all utilization management, cost containment, and medical quality improvement activities to ensure timely and quality decision making.
- Conduct medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
- Support effective implementation of performance improvement initiatives for capitated providers to optimize outcomes.
- Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
- Operate approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Function effectively within the physician committees including committee structure, processes, and membership.
- Collaborate with care management teams to assess and coordinate care for high-risk patients.
- Interface with physicians and other providers to implement recommendations that would improve utilization and healthcare quality.
- Review claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment.
- Develop alliances with the provider community through the development and implementation of medical management programs.
- Represent the business unit before various publics on medical philosophy, policies, and related issues.
Education:
- Medical Doctor or Doctor of Osteopathy degree required.
- Utilization Management experience and knowledge of quality accreditation standards preferred.
- Actively practice medicine.
- Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous.
Licenses/Certifications:
- Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services.
- Current Washington state license as a MD or DO without restrictions, limitations, or sanctions from government programs.
We offer a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements.
Centene is an equal opportunity employer committed to diversity and inclusion.
