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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. Possesses a deep understanding of clinical practices and the ability to collaborate effectively with diverse clinical teams and providers.
Highest-signal resume keywords
Board Certified PhysicianActive New York MD or DO State LicenseUtilization Management ExperienceCertification in Psychiatry SpecialtyExperience with Quality Accreditation Standards
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical ManagementQuality ImprovementUtilization ReviewClinical Quality ImprovementCost ContainmentMedical Necessity ReviewProvider Network DevelopmentHealthcare Policy PlanningPerformance Improvement InitiativesCulturally Diverse Population Management
Soft Skills
CollaborationLeadershipCommunicationInterpersonal SkillsProblem-Solving
Certifications & Qualifications
Board Certification in Medical SpecialtyCertification in Psychiatry Specialty
Industry Keywords
Quality Accreditation StandardsHealth AdministrationHealth FinancingInsurance ManagementCredentialing FunctionsPhysician Committee StructureAdverse Utilization TrendsBenefit/Payment AdequacyMedical ExpertiseProvider-Community Alliances
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 reviews for utilization review, quality assurance, and complex, controversial, or experimental services
- Support performance improvement initiatives for capitated providers
- Assist with 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 for high-risk patients and coordinate 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
- Develop and implement physician education regarding clinical issues and policies
- Identify utilization review studies, adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy
- Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice
- Interface with physicians and providers to implement recommendations improving 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 before local and national publics, state committees, and ad hoc committees as needed
Requirements
What you’ll need- Must be a Board Certified Physician
- Must have an active New York MD or DO state license
- 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
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous
- Experience treating or managing care for a culturally diverse population preferred
- Ideal candidate resides in NY or has working ties to New York
- 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