Eastern Region Behavioral Health Medical Director

Centene Corporation; Delaware; Hybrid; USD 215,000 - 409,000; Full time

Job summary

Centene Corporation is seeking a physician leader to oversee utilization management, quality improvement, and cost containment across networks. You will review complex cases, guide medical policy, and support performance improvement for capitated providers.

The role requires active medical practice with board certification and experience in quality accreditation, health administration topics, and collaboration with clinical teams to optimize patient care and payor compliance.

Qualifications

• 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.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and medical quality improvement.
• Perform medical reviews for utilization review, quality assurance, and complex medical services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care.
• Coordinate care for high-risk patients with care management teams to optimize outcomes.
• Collaborate with clinical teams, providers, appeals team, medical and pharmacy consultants on complex cases.
• Represent the business unit at state committees and other ad hoc committees.

Skills

Medical leadership

Utilization management

Quality improvement

Clinical coordination

Provider collaboration

Education

MD/DO

Board certification

Job description

Centene Corporation is seeking a physician leader to oversee utilization management, quality improvement, and cost containment across networks. You will review complex cases, guide medical policy, and support performance improvement for capitated providers.

The role requires active medical practice with board certification and experience in quality accreditation, health administration topics, and collaboration with clinical teams to optimize patient care and payor compliance.