Remote Behavioral Medical Director

Remote Behavioral Medical Director at Centene Corporation

Join us as a clinical professional on our Medical Management/Health Services team. You could be the one who changes everything for our 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

• Assist the Chief Medical Director in coordinating medical management, quality improvement, and credentialing functions for the business unit
• Provide medical leadership in utilization management, cost containment, and medical quality improvement activities
• Conduct medical review of utilization, quality assurance, and complex or experimental services, ensuring timely and quality decision making
• Support implementation of performance improvement initiatives for capitated providers
• Lead efforts to improve quality and cost-effectiveness of care and service for members
• Provide medical expertise in approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements
• Assist in the functioning of physician committees, including structure, processes, and membership
• Conduct regular rounds to assess and coordinate care for high‑risk patients, collaborating with care management teams to optimize outcomes
• Collaborate with clinical teams, network providers, appeals team, and medical and pharmacy consultants for reviewing complex cases and medical necessity appeals
• Participate in provider network development and new market expansion as appropriate
• Develop and implement physician education on clinical issues and policies
• Identify utilization review studies and evaluate adverse trends in utilization of medical services
• Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice
• Interface with physicians and other providers to facilitate implementation of recommendations to improve utilization and health‑care quality
• Review claims involving complex, controversial, or novel services to determine medical necessity and appropriate payment
• Develop alliances with the provider community through the development and implementation of medical management programs
• Represent the business unit before various publics and state committees as needed
• May be required to work weekends and holidays to support business operations as needed

• Medical Doctor or Doctor of Osteopathy
• Utilization Management experience and knowledge of quality accreditation standards (preferred)
• Actively practices medicine
• Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management (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 an 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 plus 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 characteristics 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.