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. Position Purpose: Provide medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members. Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations. Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines. Provide oversight and direction for staff and provider training and education. Promote positive relations with the local medical community, including periodic consultation with providers or prescribers. Review case management data, identifies trends and gaps in care and recommends corrective actions. Review all quality of care issues and oversees the development and implementation of processes for improvement. Monitor performance indicators to ensure the delivery of cost-effective care within quality standards. Monitor member and provider satisfaction and recommends and implements changes to improve satisfaction levels. Work collaboratively to develop corporate clinical care standards and medical practice policies. Provide medical guidance to the Medical Management department. Education/Experience: Medical Doctor (MD) or Doctor of Osteopathy required. 7 years clinical experience in the practice of medicine required. Management experience preferred. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine and provides leadership in the local medical community preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management preferred. Experience treating or managing care for a culturally diverse population preferred. Licenses/Certifications: Board certification in a medical specialty recognized by the American Board of Medical Specialists required. Certification in a primary care specialty preferred. Current Texas state license as a MD or DO without restrictions, limitations or sanctions from government programs required. For Superior HealthPlan: Must reside in Texas, required. Pay Range: $271,000.00 - $515,500.00 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, 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
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