Job Description
Job Summary
You could be the one who makes a significant impact on the healthcare industry as a clinical professional on our Medical Management/Health Services team at Centene Corporation. We are seeking a skilled Clinical Director of Medical Management to lead our medical management, quality improvement, and credentialing functions for our business unit.
This is an excellent opportunity to work with a diverse range of professionals, including physicians, nurses, and other healthcare experts, to develop and implement medical management programs that improve the quality and cost-effectiveness of care for our members.
? Provide medical leadership in all aspects of utilization management, cost containment, and medical quality improvement activities.
? Perform medical review activities related to utilization review, quality assurance, and medical review of complex or controversial medical services, ensuring timely and high-quality decision making.
? Support effective implementation of performance improvement initiatives for capitated providers.
? Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
? Collaborate effectively with clinical teams, network providers, appeals teams, and medical consultants to review complex cases and medical necessity appeals.
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