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Medical Director, Inpatient Marketplace
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 regulatory compliance and cost-effectiveness in healthcare delivery. Proven ability to collaborate with clinical teams and lead initiatives that enhance patient care and operational efficiency.
Highest-signal resume keywords
Medical Doctor Or Doctor Of OsteopathyBoard Certification In A Medical SpecialtyUtilization Management ExperienceQuality Accreditation Standards KnowledgeExperience Treating 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
Utilization ReviewQuality AssuranceMedical Service ReviewsPerformance Improvement InitiativesComplex Claims ReviewHealthcare Quality ImprovementCost Containment StrategiesClinical ManagementProvider Network DevelopmentMedical Management Programs
Soft Skills
CollaborationLeadershipCommunicationProblem-SolvingEducation And Training
Certifications & Qualifications
Board Certification In A Medical SpecialtyCurrent State License As A MD Or DO
Industry Keywords
Quality ImprovementCredentialing FunctionsRegulatory RequirementsAccreditation StandardsCulturally Diverse PopulationHealth AdministrationHealth FinancingInsurance ManagementPhysician Committee StructureCapitated Providers
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 complex, controversial, or experimental medical service reviews
- Support performance improvement initiatives for capitated providers
- Assist with goals and policies to improve quality and cost-effectiveness of care
- Provide medical expertise for quality improvement and utilization management programs meeting regulatory and accreditation requirements
- 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 and evaluate adverse utilization trends
- Facilitate provider 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
- 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
- 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 Internal or Family Medicine 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 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