Senior Medical Director, Youthcare at Centene

Overview

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.
• We’re Hiring: Senior Medical Director - YouthCare for our Illinois Health Plan.
• Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace.
• Looking for a compelling opportunity to move beyond patient encounters and drive meaningful change in the community?
• Qualifications for this role include: MD or DO without restrictions Board Certified Pediatrician or Family Medicine Must be licensed in Illinois Must reside in Illinois Position Purpose: Assist the Vice President of Medical Affairs to direct and coordinate the medical affairs functions for the business unit.
• Oversee the denials and appeals department.
• May manage other medical directors.
• Assume VPMA responsibility in absence of VPMA.
• Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities.
• Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
• Support the effective implementation of performance improvement initiatives for capitated providers.
• Assist VPMA in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
• Assist the VPMA in the functioning of the physician committees including committee structure, processes, and membership.
• Oversee the activities of physician advisors and other medical directors.
• Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
• Participate in provider network development and new market expansion as appropriate.
• Participate in provider profiling initiatives.

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