Child Psychiatrist
1 week ago
We're seeking a skilled Child Psychiatrist to lead our Medical Management/Health Services team at Centene, a renowned diversified organization offering competitive benefits and a fresh perspective on workplace flexibility.
This role involves directing and coordinating medical management, quality improvement, and credentialing functions for the business unit, with a preference for psychiatrists residing in California.
- Develop and execute medical leadership strategies to optimize utilization management, cost containment, and medical quality improvement activities.
- Conduct in-depth medical reviews for utilization review, quality assurance, and complex medical services to ensure timely and quality decision-making.
- Support the effective implementation of performance improvement initiatives for capitated providers.
- Collaborate with the Chief Medical Director to plan and establish goals and policies enhancing quality and cost-effectiveness of care and service for members.
- Provide expert medical guidance in approved quality improvement and utilization management programs, adhering to regulatory, state, corporate, and accreditation requirements.
- Assist the Chief Medical Director in overseeing physician committees, including structure, processes, and membership.
- Conduct regular rounds to assess and coordinate high-risk patient care, working closely with care management teams to optimize outcomes.
- Collaborate effectively with clinical teams, network providers, appeals teams, medical, and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Participate in provider network development and new market expansion as necessary.
- Develop and implement physician education related to clinical issues and policies.
- Evaluate adverse trends in medical service utilization, unusual provider practices, and benefit/payment adequacy.
- Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice and improve quality and cost of care.
- Interface with physicians and other providers to facilitate implementation of recommendations to improve utilization and healthcare quality.
- Review claims involving complex, controversial, or unusual services to determine medical necessity and appropriate payment.
- Establish alliances with the provider community through medical management program development and implementation.
- Represent the business unit before various publics on medical philosophy, policies, and related issues as needed.
Salary Range: The estimated annual salary for this position is $227,400.00 - $431,900.00. As a valued member of our team, you'll enjoy a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Centene values diversity and is an equal opportunity employer committed to hiring qualified individuals 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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