Supervisory Market Place Medical Director, Inpatient UM & Appeals

Centene

About The Position

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 plays a critical role in delivering medical, people leadership and expertise to ensure the delivery of high-quality, cost-effective care to our members. This role further assists the Senior Medical Director or Chief Medical Officer in execution of strategic clinical initiatives.

Requirements

Medical Doctor (MD)
Graduate of an accredited medical school required
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
Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required

Nice To Haves

Master's Degree MBA, MPH, preferred
Certification in Internal or Family Medicine specialty preferred

Responsibilities

Provide people leadership, coaching and mentorship for a team of front-line medical directors including but not limited to scheduling needed Utilization Management coverage, annual goal development, monthly 1:1s, mentorship/career development, and annual evaluations
Support Chief Medical Officer in the execution of strategic clinical initiatives
Participate in utilization review studies, evaluate adverse trends; and collaborate with CMO to develop solutions
Handle complex and high-profile utilization management cases, ensuring timely and appropriate decision-making
Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes
Conduct and participate in peer-to-peer reviews, collaborating with healthcare providers to discuss cases, answer questions, resolve disputes, and facilitate implementation of recommendations to providers that would improve utilization and health care quality
Oversee and actively participate in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements
Provide clinical guidance to care managers and support the development of individualized care plans
As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues as well as appropriate state committees and other ad hoc committees
Collaborate closely with clinical teams, appeals team, and network providers to ensure understanding and adherence to utilization management policies
Performs other duties as assigned
Complies with all policies and standards