Senior Medical Director – YouthCare
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Job Description
Senior Medical Director leading medical affairs for Illinois Health Plan at Centene Corporation. Overseeing medical leadership and quality improvement activities for Medicaid and Medicare members.
Responsibilities:
- 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
- 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
- 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
Requirements:
- MD or DO without restrictions
- Board Certified Pediatrician or Family Medicine
- Must be licensed in Illinois
- Must reside in Illinois
- 7+ years of clinical experience in the practice of medicine
- Management experience preferred
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Active practice of medicine
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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