Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
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Before you decide whether variable pay is right for your org, get a deeper understanding of the variable pay options and the cultural impact of pay choices. Subscribe to our newsletter. Assess institution performance and volume load to target areas for improvement. Experience treating or managing care for a culturally diverse population preferred. Current state medical license without restrictions. 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. View More Apply for this job. Receive alerts for other Medical Director job openings. Report this Job. Assistant Director of Nursing. Physician Clinic Medical Director.
Toggle navigation Demo. Experience CompAnalyst: Demo. Charlotte, NC. Job Posting for Medical Director at Centene Corporation Position Purpose: Assist 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. 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.
Oversees the activities of physician advisors. Utilizes the services of 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 clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
Through Service and Advancing an Inclusive Culture. At Centene, healthcare is personal. Every family, individual, and community we serve is unique. Our Purpose. At Centene, we invest in communities. Local Partnerships. Working at Centene I work in a fast-paced, caring, collaborative and energetic environment. Each day, I am given the opportunity to make a difference in the lives of our members.
By caring for the whole person, and not just a specific condition, we're able to help members address many of the barriers that can block their access to quality healthcare. Search for Jobs at Centene. Sunflower Health Plan, Centene's Kansas subsidiary, helped Jacob, an outgoing teenager with Duchenne muscular dystrophy, access both levels of his family's home and live as independently as possible. Advocating for the Mental Health of Medicare Recipients.
Home Who We Are. By the Numbers. Our Purpose. Executive Leadership. Board of Directors. This is Centene As a diversified healthcare enterprise, Centene is committed to helping people live healthier lives. Tools for Independence.
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I 55 N. Jackson, MS From Business: Some Of The Many Lines You Will Find At Helen S Include:Bailey Boys, Kissy Kissy, Petit Ami, Auraluz S, Paty, Mis- T-Vee-Us,Girlfriends, Flap Happy, Haven Girls,. Quality Healthcare Delivered Locally. Centene is a leading healthcare enterprise committed to transforming the health of the community, one person at a time. We provide a full spectrum of managed healthcare products and services, primarily through Medicaid, Medicare, and commercial products. Our core philosophy is that quality healthcare is. Centene is the largest Medicaid managed care organization in the U.S., and a leader in California, Florida, New York and Texas, four of the largest Medicaid states. Centene is also the national leader in managed long-term services and supports, and the number one carrier in the nation on the Health Insurance Marketplace.