Qureos Mentor

Centene

<div>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. 
We&rsquo;re Hiring: Full time Medical Directors in New York
Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the Health Insurance Marketplace.
Looking for a compelling opportunity to move beyond patient encounters and drive meaningful change in the community?
Qualifications for this role include:<ul><li>
MD or DO without restrictions</li><li>
Must be licensed in New York</li><li>
Board certified in Internal Medicine or Family Medicine preferred</li><li>
Utilization Management experience and knowledge of quality accreditation standards.</li></ul>
Position Purpose: 
Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.<ul><li>
Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.</li><li>
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.</li><li>
Supports effective implementation of performance improvement initiatives for capitated providers.</li><li>
Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.</li><li>
Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.</li><li>
Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.</li><li>
Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.</li><li>
Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.</li><li>
Participates in provider network development and new market expansion as appropriate.</li><li>
Assists in the development and implementation of physician education with respect to clinical issues and policies.</li><li>
Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.</li><li>
Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.</li><li>
Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.</li><li>
Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.</li><li>
Develops alliances with the provider community through the development and implementation of the medical management programs.</li><li>
As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.</li><li>
Represents the business unit at appropriate state committees and other ad hoc committees.</li><li>
May be required to work weekends and holidays in support of business operations, as needed.</li><li>
Provides clinical oversight and guidance for the MCO on Substance Use Disorder issues, including issues such as the use of ASAM or other evidence-based assessments and treatment protocols, the use of MAT, engagement with PRSS, and discharge planning for members who visit an ED or are hospitalized for an overdose.</li><li>
Consults on MCO clinical policy related to Substance Use Disorders and the cases of individual members for the MCM program on a routine basis.</li><li>
Performs other duties as assigned</li><li>
Complies with all policies and standards</li></ul> 
Education/Experience: 
Medical 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&rsquo;s Department of Certifying Board Services. (Certification in Psychiatry specialty Is required.) 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 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</div>

Medical Director

<div>You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility. 
Position Purpose: Assists in the prioritization of projects, auditing project alignment with overall technical or business strategy, guiding resource allocation, and supporting the development of project or program execution plans. Manages Agile / Lean portfolios and supports overall strategy, investment funding, Agile portfolio operations, and Lean governance. Applies the concept of lean thinking to program and product and coaches stakeholders on these concepts to achieve objectives.<ul><li>
Facilitates the portfolio management processes to ensure strategic alignment on technologies and goals</li>
<li>Develops and monitors reporting metrics and portfolio dashboards to allow for repeatable and predictable project or product release success.</li>
<li>Creates visibility into areas struggling with scope, schedule, resources, or budget</li>
<li>Contributes to the development, management and optimization of portfolio, program, and project management methodologies and disciplines</li>
<li>Facilitates resource and budget planning with the IT teams on new demands and contributes to the sequencing of projects into the portfolio</li>
<li>Identifies dependencies and critical paths, and aids stakeholders in managing them</li>
<li>Improves and streamlines the portfolio and project lifecycle, by working closely with business units, user base, and tool teams</li>
<li>Identifies and resolves problems often anticipating issues before they occur or before they escalate; develop and evaluate options and implements solutions</li>
<li>Analyzes project risk profile and balance at the portfolio level</li>
<li>Contributes to capacity planning for initial and ongoing identification of resource needs and scheduling that will be used for making critical portfolio decisions</li><li>
Performs other duties as assigned</li>
<li>Complies with all policies and standards</li></ul>
Education/Experience: Requires a Bachelor's degree and 2 &ndash; 4 years of related experience. 
 
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 
 
Technical Skills:<ul><li>
Experience with Other: ServiceNow</li><li>
Knowledge of JIRA</li></ul> 
Soft Skills:<ul><li>
Intermediate - Seeks to acquire knowledge in area of specialty</li><li>
Intermediate - Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions</li><li>
Intermediate - Ability to work independently</li></ul>
Pay Range: $73,800.00 - $132,700.00 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</div>

IT Portfolio Management Analyst II

Join Centene and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Centene

ABOUT_COMPANY

Medical Director

IT Portfolio Management Analyst II