Supervisory Medical Director, National Physical Health Appeals Outpatient UM

Position Purpose: Supervisory Medical Director at Centene provides medical and leadership expertise to ensure high-quality, cost-effective care for our members. This role further assists the Senior Medical Director and Chief Medical Officer in execution of operational and strategic clinical initiatives.

- Provides operational leadership, coaching and mentorship for a team of front-line medical directors including, but not limited to, scheduling for Utilization Management coverage, annual performance goal development, routine 1:1s, mentorship/career development, and annual evaluations. - Participates in creation and updates to new hire and existing medical director training, including new hire mentorship. - Supports Chief Medical Officer and Sr.

Medical Director in the execution of strategic clinical initiatives. - Participates in utilization review studies, performance management and trend analysis. - Handles complex and high-profile utilization management cases, ensuring timely and appropriate decision-making. - Conducts and participates in case escalation reviews, collaborating with healthcare providers and market leadership to resolve disputes and or complaints. - Oversees and actively participates in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements. - Provides clinical guidance and training to appeals medical director team around regulatory updates. - Collaborates closely with clinical teams, UM teams, and network providers to ensure understanding and adherence to utilization management clinical coverage criteria. - Performs other duties as assigned. - Complies with all policies and standards.

- Medical Doctor (MD) Graduate of an accredited medical school required - Master's Degree MBA, MPH, or epidemiologist degree preferred - 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required - 1+ years Supervisory/management experience preferred - 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 required - American Board Certification in Internal or Family Medicine, preferred. - MD - Physician - State Licensure Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required