Medical Director

4 weeks ago


Hialeah, Florida, United States Centene Full time
Job Summary

Centene is seeking a highly skilled Medical Director to lead our Behavioral Health team. As a key member of our Medical Management/Health Services team, you will play a critical role in shaping the future of healthcare for our 28 million members.

Key Responsibilities
  • Provide medical leadership and direction to our utilization management, cost containment, and quality improvement activities.
  • Conduct medical reviews of complex, controversial, or experimental medical services to ensure timely and quality decision making.
  • Support the implementation of performance improvement initiatives for capitated providers.
  • Collaborate with clinical teams, network providers, and medical consultants to optimize outcomes.
  • Develop and implement physician education programs to improve clinical quality and reduce unwarranted variation in practice.
  • Identify and evaluate trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
  • Represent the business unit before various publics on medical philosophy, policies, and related issues.
Requirements
  • Medical Doctor or Doctor of Osteopathy degree.
  • Utilization Management experience and knowledge of quality accreditation standards preferred.
  • Actively practicing medicine.
  • Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous.
  • Experience treating or managing care for a culturally diverse population preferred.
What We Offer

Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off, and a flexible approach to work with remote, hybrid, field, or office work schedules.

Centene is an equal opportunity employer 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.



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