Supervisory Medical Director, National Physical Health Appeals Outpatient UM

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Supervisory Medical Director at Centene provides medical and leadership expertise to ensure high-quality, cost-effective care for our members. This role further assists the Senior Medical Director and Chief Medical Officer in execution of operational and strategic clinical initiatives.

• Provides operational leadership, coaching and mentorship for a team of front-line medical directors including, but not limited to, scheduling for Utilization Management coverage, annual performance goal development, routine 1:1s, mentorship/career development, and annual evaluations.
• Participates in creation and updates to new hire and existing medical director training, including new hire mentorship.
• Supports Chief Medical Officer and Sr. Medical Director in the execution of strategic clinical initiatives.
• Participates in utilization review studies, performance management and trend analysis.
• Handles complex and high-profile utilization management cases, ensuring timely and appropriate decision-making.
• Conducts and participates in case escalation reviews, collaborating with healthcare providers and market leadership to resolve disputes and or complaints.
• Oversees and actively participates in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements.
• Provides clinical guidance and training to appeals medical director team around regulatory updates.
• Collaborates closely with clinical teams, UM teams, and network providers to ensure understanding and adherence to utilization management clinical coverage criteria.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Medical Doctor (MD) Graduate of an accredited medical school required
• Master's Degree MBA, MPH, or epidemiologist degree preferred
• 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required
• 1+ years Supervisory/management experience preferred
• 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 required
• American Board Certification in Internal or Family Medicine, preferred.
• MD - Physician - State Licensure Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act