- 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. 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. Oversees the activities of physician advisors. Utilizes the services of 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
-
Medical Director
4 days ago
Elevance Health North Carolina, United States· Health Solutions is focused on ensuring Elevance Health consumers have access to the highest quality, most affordable care possible. The team is responsible for driving strategic cost of care initiatives that deliver greater value, developing and advancing Elevance Health's cl ...
-
Medical Director
1 day ago
Planet Healthcare North Carolina, United StatesFull-time opportunity for a Board Certified Geriatric Medicine, Internal Medicine or Family Medicine physician to join as Medical Director of the Program of All-Inclusive Care for the Elderly. · Program of All-Inclusive Care for the Elderly (PACE) model is centered on the belief ...
-
Medical Director
1 week ago
State of North Carolina North Carolina, United StatesA Sign-on bonus of $20,000 for the successful applicant(s) of this posting. · ***See eligibility for Sign-on Bonus below in the Supplemental and Contact Information section.** · ***The primary purpose of the Medical Director/Physician is to provide advanced and/or specialized tr ...
-
Medical Director
2 weeks ago
State of North Carolina North Carolina, United States*** SIGN-ON BONUES NOW BEING OFFERED888 · A Sign-on bonus of $20,000 for the successful applicant(s) of this posting. · ***See eligibility for Sign-on Bonus below in the Supplemental and Contact Information section.** · ***Per G.S c1) (37), this position is Exempt from all provi ...
-
Associate Medical Director/Medical Director
1 week ago
Thermo Fisher Scientific North Carolina, United States Full timeOverview: Provides medical oversight of clinical trials to ensure company SOPs, client directives, good clinical practice, and regulatory requirements are followed. Attends and presents at investigator and sponsor meetings, provides medical consultation to clients, investigators ...
-
Director, Medical Director
1 week ago
Lexington Medical Center West Columbia, SC, United States Full timeLexington Medical Cancer Center is seeking a highly skilled Hematologist/Oncologist with clinical leadership experience . This Physician will serve in a primarily clinical role with the added responsibility of serving as Practice Medical Director . This is an exceptional opportun ...
-
Medical Director
1 week ago
Prisma Health West Columbia, United StatesSouth Carolina Childrens Advocacy Medical Response System - Medical Director · Columbia, SC · The University of South Carolina School of Medicine (USCSOM) is seeking a board - certified child abuse pediatrician to provide programmatic oversight of the SC Childrens Advocacy Med ...
-
Director, Medical Director
3 days ago
Ernest Health Holdings, LLC Cayce, SC, United States Full timeLexington Rehabilitation Hospital is seeking a Medical Director in Cayce, SC. · Position Overview: · Responsible for collaborating with the management team in organizing and directing the provision of physical medicine and rehabilitation services in the inpatient unit for the H ...
-
Director Medical Affairs
6 days ago
Brio Group North Carolina, United StatesJob Title: Medical Affairs Director - MSLs · Company: Oncology Biotech · Location: Remote, East Coast · Brio Resource Group is a Life Sciences Executive Search Firm committed to providing rare talent on an exclusive search basis to the Biopharma, Pharma, Device and CRO industries ...
-
Center Medical Director
2 weeks ago
Oak Street Health Columbia, SC, United StatesDescription Title: Center Medical Director · Location: Openings in Columbia, Greenville, and Spartanburg (SC). For a list of all applicable centers, see Role Description: The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value ...
-
Center Medical Director
1 week ago
Oak Street Health Columbia, SC, United StatesTitle: Center Medical DirectorLocation: Openings in Columbia, Greenville, and Spartanburg (SC). For a list of all applicable centers, see Description:The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to loca ...
-
Director - medical quality
1 week ago
MUSC Columbia, SC, United StatesMUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina. · Manages and influences relationships with senior management team, adm ...
-
Associate Medical Director
1 week ago
BlueCross BlueShield of South Carolina West Columbia, United StatesAssociate Medical Director - Concierge Care Management page is loaded · Associate Medical Director - Concierge Care Management · Apply · locations · Columbia, South Carolina · time type · Full time · posted on · Posted 3 Days Ago · job requisition id · R1034326 · Summar ...
-
Licensed Physician/Medical Director
6 days ago
Lincare South Carolina, United StatesAs America's largest supplier of respiratory and durable medical equipment, Lincare's mission is to set the standard for excellence, transforming the way respiratory care is delivered in the home. We are inspired by a vision to enable patients with chronic conditions to remain en ...
-
Associate Medical Director
1 week ago
Blue Cross Blue Shield companies West Columbia, United StatesSummary · Provides direct physician support. Oversees health and disease management programs. Oversees utilization management case evaluation for medical necessity. Reviews and communicates medical decisions. Interacts with network physician providers to resolve case-by-case comp ...
-
Senior Center Medical Director
1 week ago
ChenMed Columbia, United States Full timeWe're unique. You should be, too. · We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? · We're different than ...
-
Medical Director Adult Hospitalist
12 hours ago
Kadlec Richland, United States Full timeJoin Kadlec Regional Medical Group as a full-time Adult Hospitalist Medical Director and enjoy being part of a non profit and its exceptional and mission-driven primary care team in Richland, Washington. As medical director for Kadlec, you will work closely with facility leadersh ...
-
Hospitalist Medical Director in Walterboro, SC
2 weeks ago
TeamHEALTH South Carolina, United StatesHospitalist Medical Director in Walterboro, SC in Walterboro, SC at TeamHealth Job Description · Advance your career as a TeamHealth hospitalist medical director TeamHealth cultivates leaders to guide their teams toward goals like client retention and patient satisfaction, as we ...
-
Elevance Health North Carolina, United States Full timeJob Description · : Health Solutions is focused on ensuring Elevance Health consumers have access to the highest quality, most affordable care possible. The team is responsible for driving strategic cost of care initiatives that deliver greater value, developing and advancing El ...
-
TeamHealth West Columbia, United StatesHospitalist Medical Director in Walterboro, SC · in · Walterboro, SC · at · TeamHealth · Job Description Advance your career as a TeamHealth hospitalist medical director TeamHealth cultivates leaders to guide their teams toward goals like client retention and patient satisfa ...
Medical Director - Columbia, United States - Centene Corporation
Description
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: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
Education/Experience: Medical Doctor or Doctor of Osteopathy. 7+ years of clinical experience in the practice of medicine. 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. Current South Carolina state license as a MD or DO without restrictions, limitations, or sanctions from government programs.
Pay Range:
$206, $392,600.00 per year
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.
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.
