Remote Behavioral Medical Director

Remote Behavioral Medical Director – Centene Corporation

Join us as a clinical professional on our Medical Management/Health Services team and help transform the care experience for more than 28 million members. Centene is a diversified national organization that offers competitive benefits and a fresh perspective on workplace flexibility.

• MD or DO without restrictions
• American Board certified in Psychiatry, required
• American Board certified in Child or Addiction Psychiatry, preferred
• Utilization Management experience and knowledge of quality accreditation standards
• Actively practices medicine

• Assists the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions for the business unit
• Provides medical leadership for utilization management, cost containment, and quality improvement activities
• Performs medical review activities for utilization review, quality assurance and complex or experimental services, ensuring timely and high-quality decisions
• Supports implementation of performance improvement initiatives for capitated providers
• Assists in planning and establishing goals and policies to improve quality and cost‑effectiveness of care
• Provides medical expertise for approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
• Assists in functioning of physician committees, including structure, processes and membership
• Conducts regular rounds to assess and coordinate care for high‑risk patients, collaborating with care‑management teams to optimize outcomes
• Collaborates with clinical teams, network providers, appeals team and consultants for complex cases and medical‑necessity appeals
• Participates in provider network development and new market expansion as appropriate
• Assists in developing and implementing physician education on clinical issues and policies
• Identifies utilization‑review studies and evaluates adverse trends, unusual provider practice patterns, and adequacy of benefit/payment components
• Identifies clinical quality improvement studies to reduce unwarranted variation in practice and improve quality and cost of care
• Interfaces with physicians and other providers to facilitate implementation of recommendations to improve utilization and quality
• Reviews claims involving complex, controversial or new services to determine medical necessity and appropriate payment
• Develops alliances with the provider community through development and implementation of medical‑management programs
• May represent the business unit before various publics locally and nationally on medical philosophy, policies and related issues
• Represents the business unit at state committees and other ad‑hoc committees
• May be required to work weekends and holidays in support of business operations as needed

• Medical Doctor or Doctor of Osteopathy
• Utilization Management experience and knowledge of quality accreditation standards preferred
• Actively practices medicine
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous
• Experience treating or managing care for a culturally diverse population preferred

• Active Board certification by the American Board of Psychiatry and Neurology
• Active certification in Psychiatry specialty (required)
• Current state license as MD or DO without restrictions, limitations, or sanctions from government programs

Pay Range $ – $ per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and a flexible approach to work with remote, hybrid, field or office schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives.

Benefits may be subject to program eligibility.

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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.