Remote Behavioral Medical Director

$227,400 - $431,900/Yr

Centene - Hialeah, FL

Full-time - Executive

Remote - Hialeah, FL

Ambulatory Health Care Services

About the position

The Remote Behavioral Medical Director at Centene plays a crucial role in directing and coordinating medical management, quality improvement, and credentialing functions within the organization. This position involves providing medical leadership for utilization management, ensuring quality decision-making in medical reviews, and supporting performance improvement initiatives. The director will collaborate with various teams to optimize patient outcomes and participate in provider network development, all while adhering to regulatory and accreditation standards.

Responsibilities

• Assist the Chief Medical Director in directing and coordinating medical management functions.
• Provide medical leadership for utilization management and quality improvement activities.
• Perform medical review activities for utilization review and quality assurance.
• Support the implementation of performance improvement initiatives for capitated providers.
• Assist in planning and establishing goals to improve quality and cost-effectiveness of care.
• Provide medical expertise in quality improvement and utilization management programs.
• Assist in the functioning of physician committees.
• Conduct regular rounds to assess and coordinate care for high-risk patients.
• Collaborate with clinical teams and providers for reviewing complex cases.
• Participate in provider network development and market expansion.
• Assist in developing physician education on clinical issues and policies.
• Identify and evaluate trends in utilization of medical services.
• Identify clinical quality improvement studies to reduce variation in practice.
• Interface with providers to implement recommendations for improving utilization and quality.
• Review claims for medical necessity and appropriate payment.
• Develop alliances with the provider community through medical management programs.
• Represent the business unit at state committees and other ad hoc committees.

Requirements

• Medical Doctor or Doctor of Osteopathy degree.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Active practice of medicine.
• Coursework in Health Administration, Health Financing, Insurance, or Personnel Management is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.
• Board certification by the American Board of Psychiatry and Neurology in Psychiatry specialty is required.
• Current state license as a MD or DO without restrictions.

Nice-to-haves

• Addictions training preferred.
• Child training preferred.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules including remote, hybrid, field, or office work.