Behavioral Medical Director - Eastern Region (Remote/Hybrid)

Centene Corporation; Nashville (TN); Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the Clinical & Care Management area. You will lead utilization review, quality assurance, and complex case reviews to ensure timely, high-quality decisions and cost-effective care.

The role requires board certification, active medical practice, and experience in accreditation standards.

Qualifications

• Active medical practice and leadership experience in medical management.
• Experience with utilization management and quality accreditation standards.
• Eligibility to practice in the United States and state licensure in good standing.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing for the unit.
• Provide medical leadership for utilization management and cost containment.
• Participate in provider network development and mechanism for clinical issue resolution.
• Lead education for physicians on clinical policies and review processes.
• Review complex or new services for medical necessity and appropriate payment.

Skills

Medical leadership

Quality improvement

Clinical collaboration

Regulatory knowledge

Education

Doctor of Medicine or Doctor of Osteopathy

ABPN board certification

MD/DO license (active)

Job description

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the Clinical & Care Management area. You will lead utilization review, quality assurance, and complex case reviews to ensure timely, high-quality decisions and cost-effective care.

The role requires board certification, active medical practice, and experience in accreditation standards.