Chief MD, Physical Health (UM)
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
Lead a team of physicians responsible for utilization management, including concurrent review, prior authorization, and appeals, through innovative and cost-effective utilization management. Coach and upskill key talent... across the team to deliver excellence.
Serve as the point of accountability for escalated clinical issues, including internal and external appeals, member and provider complaints, and grievances. Manage complex case management escalations with a focus on resolution and customer satisfaction.
Identify and deliver on UM KPIs/metrics that are aligned with the strategic direction of the organization.
Establish collaborative relationships with cross-functional divisions at both enterprise level and across health plans, in particular PHCO.
Serve as a subject matter expert on utilization management and healthcare delivery trends and practices.
Identify trends and opportunities for continuous improvement and innovation in UM process. Achieve best in class performance through regular review and analysis of UM related productivity and quality data.
Ensure compliance with all relevant regulations and standards.
Collaborate with and contribute to breadth of cross-functional product lines involving Medical Affairs (Medicare & Marketplace).
Perform other duties as assigned, contributing to the overall success and effectiveness of the utilization management department.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists. 7+ years relevant experience in utilization management space and as a people leader. Previous experience as Medical Director is preferred. Masters degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
License/Certificates: Board Certification through American Board of Medical Specialists. Current state medical license without restrictions.Pay Range: $289,700.00 - $550,500.00 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. 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
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