Medical Director, Quality & Utilization Leader

Centene Corporation; New York (NY); Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Health insurance

401K & stock purchase

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation is seeking a Board-certified physician to lead medical management and quality improvement for the business unit in New York. The role requires NY MD/DO licensure, and active clinical involvement with collaboration across care management and provider networks.

The position emphasizes oversight of utilization management, medical review, and performance improvement initiatives to ensure high-quality and cost-effective care for members.

Qualifications

• Board-certified physician with NY license required.
• Utilization management experience preferred.
• Experience treating a culturally diverse population preferred.
• Active medical practice is advantageous.

Responsibilities

• Provide medical leadership for utilization management and quality improvement activities.
• Perform medical reviews for utilization review, quality assurance, and review of complex or unusual services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care.
• Provide medical expertise in approved quality improvement and utilization management programs.

Skills

Medical leadership

Utilization management

Quality improvement

Provider collaboration

Regulatory compliance

Education

MD/DO

Job description

Centene Corporation is seeking a Board-certified physician to lead medical management and quality improvement for the business unit in New York. The role requires NY MD/DO licensure, and active clinical involvement with collaboration across care management and provider networks.

The position emphasizes oversight of utilization management, medical review, and performance improvement initiatives to ensure high-quality and cost-effective care for members.