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Associate Medical Director
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Senior Center Medical Director
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Medical Director Role in Columbia SC
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Associate Medical Director, Client Support
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Hayman Daugherty Associates, Inc Columbia, United StatesJob Overview · A large metro hospital is seeking a GI medical director with 5-10 years of experience and academic ties. · A GI fellowship program is in the planning stages and the system is looking to expand the department once a director is found. Prior leadership experience is ...
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Certified MC Med Tech
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Hayman Daugherty Associates, Inc Columbia, United StatesJob Overview · Pulmonology/Critical Care Physician Job Near Columbia, SC · An excellent opportunity for a fellowship trained Pulmonology/Critical Care; Pulmonologist; or Pulmonology/Sleep physician to join a hospital-based group. It is open to Pulmonologists with or without Criti ...
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Executive Assistant I
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Hayman Daugherty Associates, Inc Columbia, United StatesJob Overview · Gastroenterology Physician Job near Columbia, SC · Seeking a BC/BE Gastroenterologist to join an established hospital affiliated practice located near Columbia, South Carolina. The established provider is retiring and we are seeking a physician who would like to en ...
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General Surgeon Needed in Columbia, SC
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Audiology Tech
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Audiology Tech
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Charleston ENT & Allergy Columbia, United StatesPalmetto ENT & Allergy is now hiring for a part-time Audiology Tech to join our growing audiology department. The Audiology tech will work under the supervision of the Audiologists in the delivery of services to our patients. · Duties include, but are not limited to: Verify Insu ...
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DADE/ ID Medical Consultant
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Physician - Radiation Oncologist - Columbia
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Memory Care Manager
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Memory Care Manager
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Prisma Health Columbia, United StatesInspire health. Serve with compassion. Be the difference. · Job Summary · The Prisma Health Physician is responsible for the provision of quality medical services to patients of Prisma Health-University Medical Group · Accountabilities Depending on setting and specialty, provi ...
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Director of Individual Giving and Major Gifts
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Staff Development Nurse
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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.
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. 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
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 yearCentene 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. Total compensation may also include additional forms of incentives.
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.
