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Behavioral Health Medical Director
Centene Corporation. Assist the Chief Medical Director to direct and coordinate medical management, quality improvement, and credentialing functions .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical management, quality improvement, and utilization management, with a strong focus on cost containment and enhancing healthcare quality. Possesses a solid foundation in clinical leadership and collaboration with diverse healthcare teams to drive performance improvement initiatives.
Highest-signal resume keywords
Medical Doctor (MD) or Doctor of Osteopathy (DO)Board Certification in PsychiatryUtilization Management ExperienceQuality Improvement ProgramsCurrent State Medical License
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ReviewQuality AssuranceMedical Service ReviewsPerformance Improvement InitiativesClinical Quality Improvement StudiesComplex Claims ReviewHealthcare Quality ImprovementCost-Effectiveness PlanningMedical Management ProgramsProvider Network Development
Soft Skills
CollaborationLeadershipCommunicationCultural CompetenceEducation and Training
Certifications & Qualifications
Board Certification by the American Board of Psychiatry and Neurology
Industry Keywords
Quality Accreditation StandardsHealth AdministrationHealth FinancingInsurance ManagementCulturally Diverse Population
About the role
Key responsibilities & impact- Assist the Chief Medical Director to direct and coordinate medical management, quality improvement, and credentialing functions
- Provide medical leadership for utilization management, cost containment, and medical quality improvement activities
- Perform utilization review, quality assurance, and complex, controversial, or experimental medical service reviews
- Support performance improvement initiatives for capitated providers
- Assist in planning goals and policies to improve quality and cost-effectiveness of care
- Provide medical expertise for quality improvement and utilization management programs
- Assist with physician committee structure, processes, and membership
- Conduct regular rounds to assess and coordinate care for high-risk patients
- Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants
- Participate in provider network development and new market expansion
- Support physician education on clinical issues and policies
- Identify utilization review and clinical quality improvement studies and evaluate adverse utilization trends
- Facilitate provider implementation of recommendations to improve utilization and healthcare quality
- Review complex claims to determine medical necessity and appropriate payment
- Develop provider-community alliances through medical management programs
- Represent the business unit before public and state or ad hoc committees as needed
Requirements
What you’ll need- Medical Doctor or Doctor of Osteopathy
- Board certification in Psychiatry
- Board certification by the American Board of Psychiatry and Neurology
- Current state medical license as an MD or DO without restrictions, limitations, or sanctions from government programs
- Actively practices medicine
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous
- Experience treating or managing care for a culturally diverse population preferred
- May be required to work weekends and holidays in support of business operations, as needed
Benefits
Comp & perks- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
- additional forms of incentives may be included in total compensation