Chief Medical Director
Chief Medical Director Washington, District of Columbia Apply Now Job ID 009UN Category Physicians Organization Centene Corporation Schedule Full-time Description:
Position Purpose:
Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures.
Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.
Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.
Responsible for HEDIS improvement and strategy.
Actively participates in the auditing process of medical management processes and corrective action team projects for medical management Achieves utilization, cost management and quality goals.
Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology
Qualifications:
Education/
Experience:
Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists.
Volunteer patient care required.
Previous experience as Medical Director is preferred.
Master's degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
License/Certificates:
Board Certification through American Board of Medical Specialists.
Current state medical license without restrictions.
Apply Now See what's near our Washington DC location.
Learn more about our hiring process and discover other helpful information for applicants.
Join our Talent Network and get Centene news and job alerts delivered to your inbox.
Let us search jobs for you based on the skills and experience listed in your LinkedIn Profile.
Transforming the health of the community, one person at a time.
Our local approach allows us to help members access high-quality, culturally sensitive healthcare services.
We invest in local communities and the lives of our members in as many ways as we can.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
Position Purpose:
Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures.
Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.
Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.
Responsible for HEDIS improvement and strategy.
Actively participates in the auditing process of medical management processes and corrective action team projects for medical management Achieves utilization, cost management and quality goals.
Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology
Qualifications:
Education/
Experience:
Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists.
Volunteer patient care required.
Previous experience as Medical Director is preferred.
Master's degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
License/Certificates:
Board Certification through American Board of Medical Specialists.
Current state medical license without restrictions.
Apply Now See what's near our Washington DC location.
Learn more about our hiring process and discover other helpful information for applicants.
Join our Talent Network and get Centene news and job alerts delivered to your inbox.
Let us search jobs for you based on the skills and experience listed in your LinkedIn Profile.
Transforming the health of the community, one person at a time.
Our local approach allows us to help members access high-quality, culturally sensitive healthcare services.
We invest in local communities and the lives of our members in as many ways as we can.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
