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Behavioral Health Medical Director
Centene Corporation. Assist the Chief Medical Director in directing and coordinating 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. Holds board certification in Psychiatry and possesses a valid medical license in the relevant states.
Highest-signal resume keywords
Board Certified PsychiatristUtilization Management ExperienceMedical Doctor or Doctor of OsteopathyQuality Improvement ExpertiseCurrent State Medical License
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Medical ManagementQuality ImprovementUtilization ReviewClinical Quality ImprovementCost ContainmentMedical Necessity ReviewHealthcare QualityProvider Network DevelopmentCulturally Diverse Population CarePerformance Improvement Initiatives
Soft Skills
CollaborationLeadershipCommunicationEducationCoordination
Certifications & Qualifications
Board Certification in PsychiatryBoard Certification by the American Board of Psychiatry and Neurology
Industry Keywords
Quality Accreditation StandardsHealth AdministrationHealth FinancingInsurancePersonnel Management
About the role
Key responsibilities & impact- Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions
- Provide medical leadership for utilization management, cost containment, and medical quality improvement activities
- Perform medical review for utilization review, quality assurance, and complex, controversial, or experimental services
- Support performance improvement initiatives for capitated providers
- Assist in establishing 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 for high-risk patients and coordinate care with care management teams
- Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants
- Participate in provider network development and new market expansion
- Assist with physician education on clinical issues and policies
- Identify utilization review studies, adverse utilization trends, unusual provider patterns, and benefit/payment adequacy
- Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice
- Interface with physicians and providers to improve utilization and healthcare quality
- Review complex, controversial, unusual, or new-service claims for medical necessity and appropriate payment
- Develop provider-community alliances through medical management programs
- Represent the business unit publicly and at state or ad hoc committees as needed
Requirements
What you’ll need- Must be a Board Certified Psychiatrist
- Licensed in California, Oregon, Washington or Nevada
- Medical Doctor or Doctor of Osteopathy
- Actively practices medicine
- 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
- Certification in Psychiatry specialty is required
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs
- For Behavioral Health: Board certification by the American Board of Psychiatry and Neurology
- Current state medical license without restrictions
- 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
- Highly preferred: candidate lives in the Pacific Time Zone
- May be required to work weekends and holidays as needed
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity