Medical Director jobs

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18 Medical Director roles

Remote Medical Director, Inpatient Marketplace
Remote
Centene
7 LocationsPosted yesterday
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Medical Director - Florida Medicare
Elevance Health
3 LocationsPosted yesterday
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Medical Director, Post Acute Care
Cigna
United States Work at HomePosted yesterday
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Site Medical Director
AltaMed Health Services
Commerce, CAPosted 4 days ago
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Site Medical Director, Geriatric
AltaMed Health Services
Huntington Park, CAPosted 4 days ago
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Medical Director
Remote
Centene
Remote-INPosted 4 days ago
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Medical Director
Highmark Health
51 LocationsPosted 5 days ago
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Medical Director
Elevance Health
10 LocationsPosted 7 days ago
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Medical Director - Addiction Medicine
Acadia Healthcare
West Milwaukee, WIPosted 7 days ago
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Medical Director - Addiction Medicine
Acadia Healthcare
Anchorage, AKPosted 7 days ago
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Medical Director
Remote
Flatiron Health
Remote - USPosted 7 days ago
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Medicare Advantage Utilization Management Physician Medical Director
SCAN Health Plan
Los Angeles, CAPosted 8 days ago
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Chief & Medical Director of Anesthesiology $75K Sign-On 10 Weeks PTO 10 Holidays Mass General Brigham Northampton, MA
Mass General Brigham
Northampton-MAPosted 8 days ago
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Medical Director
Elevance Health
5 LocationsPosted 8 days ago
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Medical Director, Inpatient Dialysis, St. George Regional Hospital
Intermountain Health
Intermountain Health St George Regional HospitalPosted 8 days ago
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Remote Medical Director, Appeals
Remote
Centene
10 LocationsPosted 13 days ago
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Physician Medical Director, Pain Service
Veterans Health Administration
Augusta, GeorgiaPosted 13 days ago
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Medical Director EX
AdventHealth
ADVENTHEALTH ORLANDO
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Remote

Medical Director

Remote Medical Director, Inpatient Marketplace

Company: Centene
Location: 7 Locations
Posted: Posted yesterday

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The job

Position Purpose

Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.
Supports effective implementation of performance improvement initiatives for capitated providers.
Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
Participates in provider network development and new market expansion as appropriate.
Assists in the development and implementation of physician education with respect to clinical issues and policies.
Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
Develops alliances with the provider community through the development and implementation of the medical management programs.
As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
Represents the business unit at appropriate state committees and other ad hoc committees.
May be required to work weekends and holidays in support of business operations, as needed.

Education/Experience

Medical Doctor or Doctor of Osteopathy.
Utilization Management experience and knowledge of quality accreditation standards preferred.
Actively practices medicine.
Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
Experience treating or managing care for a culturally diverse population preferred.

License/Certifications

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.
Certification in Internal or Family Medicine, preferred.
Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Pay Range: $215,000.00 - $408,500.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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

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Remote Medical Director, Inpatient Marketplace

Medical Director - Florida Medicare

Medical Director, Post Acute Care

Site Medical Director

Applying to a few of these?

Site Medical Director, Geriatric