Supervisory Market Place Medical Director, Inpatient UM & Appeals

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: Supervisory Medical Director at Centene plays a critical role in delivering medical, people leadership and expertise to ensure the delivery of high-quality, cost-effective care to our members. This role further assists the Senior Medical Director or Chief Medical Officer in execution of strategic clinical initiatives.

• Provide people leadership, coaching and mentorship for a team of front-line medical directors including but not limited to scheduling needed Utilization Management coverage, annual goal development, monthly 1:1s, mentorship/career development, and annual evaluations

• Support Chief Medical Officer in the execution of strategic clinical initiatives

• Participate in utilization review studies, evaluate adverse trends; and collaborate with CMO to develop solutions

• Handle complex and high-profile utilization management cases, ensuring timely and appropriate decision-making

• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes

• Conduct and participate in peer-to-peer reviews, collaborating with healthcare providers to discuss cases, answer questions, resolve disputes, and facilitate implementation of recommendations to providers that would improve utilization and health care quality

• Oversee and actively participate in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements

• Provide clinical guidance to care managers and support the development of individualized care plans

• As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues as well as appropriate state committees and other ad hoc committees

• Collaborate closely with clinical teams, appeals team, and network providers to ensure understanding and adherence to utilization management policies

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience:

• Medical Doctor (MD) Graduate of an accredited medical school required
• Master's Degree MBA, MPH, preferred
• 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required
• 1+ years Supervisory/management experience preferred
• 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 required
• Certification in Internal or Family Medicine specialty preferred
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required
   

Centene offers 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.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act