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Behavioral 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 focus on enhancing healthcare quality and cost-effectiveness. Possesses strong leadership skills to collaborate with clinical teams and develop provider-community alliances.
Highest-signal resume keywords
Medical Doctor (MD) Or Doctor Of Osteopathy (DO)Board Certification In Psychiatry And NeurologyUtilization Management ExperienceQuality Accreditation Standards KnowledgeCertification In Child Psychiatry
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 ReviewPerformance Improvement InitiativesClinical Quality Improvement StudiesEvaluation Of Utilization TrendsProvider Practice Patterns AnalysisMedical Necessity ReviewCost Containment StrategiesHealthcare Quality Improvement
Soft Skills
CollaborationLeadershipCommunicationCultural CompetenceEducation And Training
Certifications & Qualifications
Board Certification By The American Board Of Psychiatry And NeurologyCurrent State License As An MD Or DOCertification In Child Psychiatry
Industry Keywords
Medical ManagementQuality ImprovementCredentialing FunctionsCapitated ProvidersHealthcare QualityProvider Network DevelopmentCulturally Diverse PopulationHealth AdministrationHealth FinancingInsurance 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 utilization review, quality assurance, and medical review of 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 on complex cases and appeals
- 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
- Evaluate utilization trends, provider practice patterns, and benefit/payment components
- 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 on medical philosophy, policies, state committees, and other ad hoc committees as needed
Requirements
What you’ll need- Medical Doctor or Doctor of Osteopathy
- Actively practices medicine
- Board certification by the American Board of Psychiatry and Neurology
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Certification in Child Psychiatry 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
- 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