Remote Medical Director - New York - Fidelis Care - New York : Job Details

Join to apply for the Remote Medical Director - New York role at Fidelis Care - New York

Continue with Google Continue with Google

Join to apply for the Remote Medical Director - New York role at Fidelis Care - New York

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Position PurposeAssist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

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

Education/ExperienceMedical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred.License/Certifications Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services. Current New York state license as a MD or DO without restrictions, limitations, or sanctions from government programs.Pay Range $231,900.00 - $440,500.00 per yearCentene 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

Seniority level

• Seniority levelNot Applicable

Employment type

• Employment typeFull-time

Job function

• Job functionHealth Care Provider
• IndustriesHospitals and Health Care and Insurance

Referrals increase your chances of interviewing at Fidelis Care - New York by 2x

Get notified about new Medical Director jobs in New York, United States.

New York, NY $200,000 - $300,000 21 hours ago

New York, NY $300,000 - $375,000 1 day ago

Dermatology Field Director (Northeast) -Janssen Scientific Affairs, LLC.

New York, NY $160,000 - $280,000 2 weeks ago

New York, NY $230,000 - $245,000 1 week ago

Associate Director, Global Field Medical Operations

New York, NY $190,000 - $215,000 1 week ago

New York, NY$115,000.00-$118,000.001 week ago

Medical Director/Global Medical Indication Lead - Nephrology(FSP)

New York, United States$200,000.00-$278,900.001 week ago

Director of Strategic Accounts (Tri-State)

New York, NY$190,000.00-$240,000.001 week ago

Sr Medical Director/Global Medical Indication Lead - Rheumatology(Client Dedicated)

New York, United States$200,000.00-$278,900.001 week ago

New York, NY$170,000.00-$200,000.001 day ago

New York, NY$95,000.00-$103,000.001 week ago

Physician: Medical Director for MedSpas (NY)

New York, United States$650.00-$6,500.003 months ago

New York, United States$104,500.00-$156,000.001 week ago

Clinical Documentation Improvement Manager - Mount Sinai Health Partners - Remote

New York, NY$78,884.00-$118,326.003 hours ago

Brooklyn, NY$80,000.00-$100,000.003 months ago

Clinical Documentation Improvement Manager - Mount Sinai Health Partners - Remote

New York, NY$78,884.00-$118,326.001 week ago

New York, NY$108,815.00-$108,815.001 week ago

Medical Geneticist Advisor at Healthcare Venture Capital Fund - Healthcare Shares

New York, NY$86,500.00-$86,500.002 weeks ago

New York, NY$108,815.00-$108,815.001 week ago

Manager, Medical Economics (Pop Health/Clinical Analytics) - REMOTEManager, Medical Economics (Marketplace) - REMOTE

New York, NY $108,815 - $108,815 1 week ago

New York, NY $108,815 - $108,815 1 week ago

Oneida County, NY $110,000 - $160,000 1 day ago

Business Development Manager - Medical Device

Buffalo, NY $130,000 - $150,000 2 weeks ago

NP/PA - General Surgery - Telemedicine (Bariatrics)

We're unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

#J-18808-Ljbffr