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Medical Director
Centene Corporation. Assist the Chief Medical Director to direct and coordinate medical management, quality improvement, and credentialing functions for the business unit .
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 regulatory compliance and cost-effectiveness in healthcare delivery. Proven ability to collaborate with clinical teams and develop provider-community alliances to enhance healthcare quality.
Highest-signal resume keywords
MD Or DO LicenseBoard Certification In PsychiatryUtilization Management ExperienceQuality Accreditation Standards KnowledgeExperience With Culturally Diverse Populations
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 ReviewMedical Necessity AssessmentPerformance Improvement InitiativesClinical Quality ImprovementCost Containment StrategiesCredentialing FunctionsComplex Case CollaborationProvider Network Development
Soft Skills
LeadershipCollaborationCommunicationProblem-SolvingEducation
Certifications & Qualifications
Board Certification In Medical SpecialtyCertification In Psychiatry Specialty
Industry Keywords
Healthcare QualityAccreditation RequirementsCulturally Diverse PopulationHealth AdministrationHealth FinancingInsurance Management
About the role
Key responsibilities & impact- Assist the Chief Medical Director to direct and coordinate medical management, quality improvement, and credentialing functions for the business unit
- Provide medical leadership for utilization management, cost containment, and medical quality improvement activities
- Perform medical review activities for utilization review, quality assurance, and complex, controversial, or experimental medical services
- Support performance improvement initiatives for capitated providers
- Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service
- Provide medical expertise for quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
- 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 on complex cases and medical necessity appeals
- Participate in provider network development and new market expansion
- Assist in physician education regarding clinical issues and policies
- Identify utilization review studies and evaluate adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy
- Identify clinical quality improvement studies to reduce unwarranted variation and improve quality and cost of care
- 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- MD or DO without restrictions
- Must be licensed in one of the following states: Missouri, Illinois, Kansas, Iowa, Nebraska, Michigan, Wisconsin, Indiana, Ohio, or Pennsylvania
- 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
- May be required to work weekends and holidays as needed
Benefits
Comp & perks- 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