Centene Corporation

Centene Corporation Dania Beach, FL, USA
Jul 24, 2021
Full time
Position purpose Provide medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members. 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...
Centene Corporation Camp Hill, PA 17011, USA
Jul 08, 2021
Full time
Position Purpose Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures. Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations. Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation. Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Facilitates the achievement of the Medical Management Program goals through an effective...