Remote Medical Director, Appeals

Centene

Multiple Locations, US
$236,500.00 - $449,300.00 py
Remote
Medical leadership
Utilization management
Quality improvement activities
Centene is seeking a Remote Medical Director for Appeals, responsible for overseeing medical management, quality improvement, and utilization management functions. The role emphasizes collaboration with clinical teams and provider networks to enhance care quality and cost-effectiveness

Job Summary

  • 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.
  • Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.

Matching Summary

Match Score: 85

Centene is seeking a Remote Medical Director for Appeals, responsible for overseeing medical management, quality improvement, and utilization management functions. The role emphasizes collaboration with clinical teams and provider networks to enhance care quality and cost-effectiveness.

Salary

$236,500.00 - $449,300.00 per year

Skills & Requirements

Must-have

  • Medical leadership
  • Utilization management
  • Quality improvement activities
  • Medical review of complex services
  • Provider network development
  • Clinical quality improvement studies

Nice-to-have

  • Culturally diverse population experience
  • Health Administration coursework
  • Health Financing coursework
  • Insurance coursework
  • Personnel Management coursework

Key Requirements

  • Medical Doctor or Doctor of Osteopathy
  • Actively practices medicine
  • Board certification in a medical specialty
  • Current unrestricted state license as MD or DO

Work Rights

Not specified

Tailored Resume

Cover Letter