- 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
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Behavioral Medical Director
1 week ago
Centene Corporation Baton Rouge, United StatesYou 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.* ...
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Clinic Medical Director
4 weeks ago
VieMed Healthcare Staffing Baton Rouge, United States TEMPORARYStart Date: ASAP · Shift: Days · We are an equal opportunity employer, and all qualified applicants will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or a ...
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Medical Director of Quality Management
1 week ago
SCP Health Baton Rouge, LA, United States Full timeSystem Director, Emergency Medicine* · Contributes to SCP Health and Baton Rouge General's goals as a leader in the provision of Emergency Medicine practice management. Accountable to lead and direct clinical and operational services at a designated group of Emergency Medicine pr ...
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Emergency Medicine System Medical Director
4 days ago
SCP Health Baton Rouge, LA, United States Full time*JOB TITLE: System Director, Emergency Medicine* · Contributes to SCP Health and Baton Rouge General's goals as a leader in the provision of Emergency Medicine practice management. Accountable to lead and direct clinical and operational services at a designated group of Emergency ...
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Titan Industries Baton Rouge, United StatesOur client is a renowned hospital located in the Southwest Palatinate region with a broad medical care mandate and a future-oriented focus. The hospital stands out for its proactive and strategically thought-out actions, particularly in the continuous adaptation and optimization ...
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Medical Assistant
1 week ago
RWJBarnabas Health Livingston, United StatesJob Overview: · Under the direction of the Laboratory Supervisor, PCC, and Assistant Director of Clinical Services the Medical Assistant is a skilled healthcare professional providing quality care to patients. The Medical Assistant is specially trained to perform both administrat ...
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rn icu nights prn
1 week ago
Livingston Regional Hospital Livingston, United States Full timeDescription · At Livingston Regional Hospital, we recognize that our patients deserve qualified, engaged, and competent nurses. And we know that our nurses deserve a working environment that is safe, leaders who are visible and supportive, and opportunities to grow and develop. W ...
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RN Oakpoint NIGHTS
1 week ago
Livingston Regional Hospital Livingston, United States Full timeDescription · At Livingston Regional Hospital, we recognize that our patients deserve qualified, engaged, and competent nurses. And we know that our nurses deserve a working environment that is safe, leaders who are visible and supportive, and opportunities to grow and develop. W ...
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Director of Nursing
1 week ago
IAH Detention Center Livingston, United StatesManagement & Training Corporation operates the **IAH Detention Center **in **Livingston, Texas, **providing residents with excellent care including medical services supporting their health and well-being. · **Position**:Director of Nursing, DON · **Salary**:$85,000 · **Benefits i ...
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Executive Director
3 days ago
Embark Behavioral Health Livingston, United StatesOverview: · **Salary : Up to $115,000/yr ( DOE)** · Embark Behavioral Health is looking for an individual committed to reducing adolescent anxiety, depression and suicide to oversee our new OP/IOP/PHP clinic in Livingston, NJ. · Embark operates facilities across the US that suppo ...
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Store Director
3 days ago
J. Crew Factory Livingston, United StatesOur Story · We're J.Crew Factory, and we believe shopping should be fun. Our brand is built on creating timeless styles that last season after season—while still making sure to stay in front of what's next. We also believe in looking like a million bucks, not spending it, which i ...
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Maintenace Supervisor
1 week ago
Spring Hills Livingston AL Livingston, United StatesAward winning company focused on employee experience. I**NVESTING IN YOUR FUTURE** with, **COMPETITIVE** pay, matching 401k, education and training. **CARING** about your work/life balance with flexible scheduling & **GENEROUS PTO. #FINDINGYOURHAPP**Y with Employee Committee, rew ...
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Nurse Practitioner
5 days ago
Milan Laser Company Commerce Park, United StatesAbout Milan Laser Hair Removal · Milan Laser Hair Removal is one of the nation's premier laser hair removal providers. That's because we only use top of the line lasers, and all our treatments are performed by licensed medical professionals. Additionally, we guarantee our clients ...
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Registered Nurse
1 week ago
Ochsner Home Health of Baton Rouge Careers Baton Rouge, United States Permanent, Full timeWe are hiring for a Registered Nurse. · At Ochsner Home Health Baton Rouge, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve—it truly is all ...
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LHRC Direct Service Worker
1 week ago
LA Health and Rehab, Inc. Baton Rouge, United StatesLHRC is looking for Overnight/ Weekend Direct Service Workers for Baton Rouge, LA and surrounding areas. · Job Title: Direct Service Worker · Reports To: Program Director · FLSA Status: Non-Exempt · Division: Direct Care · FUNCTION: This position has the responsibility of being ...
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Medical Laboratory Technician PD
2 days ago
FORTIS Colleges and Institutes Baton Rouge, United StatesMEDICAL LABORATORY TECHNICIAN PROGRAM DIRECTOR · About the Role: · Fortis Institute located in Baton Rouge, LA is preparing to start a Medical Laboratory Technician program. This will be an Associate program, 2 years in length, located in a large city with a thriving medical comm ...
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Central Service Worker 2
1 week ago
Louisiana State University Healthcare Network: New Orleans Baton Rouge, United StatesTo provide services, as well as to supply, process, maintain, and distribute medical supplies and equipment throughout state health care facilities. · Under the direct minimal supervision will report to the Director of Clinical Staff and Patient Services. Primary responsibilities ...
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Fundraising Events Manager, Louisiana
3 hours ago
American Foundation for Suicide Prevention Baton Rouge, United StatesJob Description · REPORTS TO: Executive Director, Louisiana & Mississippi · LOCATION: Must Reside within Assigned Chapter Territory (either Louisiana or Mississippi) · POSITION SUMMARY: · Responsible for implementing AFSP fundraising events and revenue generating initiatives wit ...
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Fundraising Events Manager, Louisiana
3 days ago
American Foundation for Suicide Prevention Baton Rouge, United StatesJob Description · REPORTS TO: Executive Director, Louisiana & Mississippi · LOCATION: Must Reside within Assigned Chapter Territory (either Louisiana or Mississippi) · POSITION SUMMARY: · Responsible for implementing AFSP fundraising events and revenue generating initiatives wit ...
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rn pacu
6 days ago
The Spine Hospital of Louisiana Baton Rouge, United StatesJob Type · Full-time · Description · Responsible for providing care to post-operative patients recovering from anesthesia , including general, regional, and local until admitted to the inpatient unit or discharged from The Spine Hospital of Louisiana.Utilizes assessment skills an ...
Behavioral Medical Director - Baton Rouge, 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 by the American Board of Psychiatry and Neurology. Current Louisiana state medical license without restrictions state medical license without restrictions, limitations, or sanctions from government programs.
Pay Range:
$217, $412,300.00 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.
Behavioral Medical Director professionals in Baton Rouge
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Christi Brown
An enthusiastic licensed mental health professional with extensive clinical experience distinguished ...