Chief Medical Director
Indianapolis , IN, USA | Centene Corporation
Industry:Healthcare - Hospitals
Job Description:108 people have viewed this job
Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the plan, establishing the vision and attendant policies and procedures.
Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.
Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.
Responsible for HEDIS improvement and .
Actively participates in the auditing process of medical management processes and corrective action team projects for medical management
Achieves utilization, cost management and quality goals.
Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology
For Home State Health Plan only – responsible for the sufficiency and supervision of the health plan provider network
Education/Experience: Medical Doctor or Doctor of Osteopathy, certified in a specialty recognized by the American of Medical Specialists. Volunteer patient care required. Previous experience as Medical is preferred. ’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
License/Certificates: Certification through American of Medical Specialists. Current state medical license without restrictions.
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