Medical Director: Quality & Utilization Leader

centene; New York (NY); On-site; 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 schedules (remote/hybrid

Job summary

Centene seeks a Board-certified physician to serve as Medical Director for medical management, quality improvement and credentialing within the NY market. The role partners with the Chief Medical Director to direct utilization management, cost containment and clinical performance initiatives.

The ideal candidate resides in NY or maintains strong working ties to the state, holds an active NY MD or DO license, and brings leadership across clinical teams, networks, and payer collaborations to

Qualifications

• Board certification in a medical specialty; NY MD/DO license required.
• Utilization Management experience and knowledge of accreditation standards.
• Experience treating or managing care for culturally diverse populations.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical review for utilization, quality assurance, and complex or new services.
• Support performance improvement initiatives for capitated providers.
• Plan and implement goals and policies to improve care quality and cost-effectiveness.
• Collaborate with clinical teams, providers, and consultants on complex cases.
• Engage in provider network development and market expansion.
• Develop physician education on clinical issues and policies.
• Review claims for medical necessity and appropriate payment.

Skills

Board Certification

MD/DO License

Utilization Management

Quality Improvement

Medical Leadership

Provider Network

Care Management

Regulatory Compliance

Education

MD

DO

Job description

Centene seeks a Board-certified physician to serve as Medical Director for medical management, quality improvement and credentialing within the NY market. The role partners with the Chief Medical Director to direct utilization management, cost containment and clinical performance initiatives.

The ideal candidate resides in NY or maintains strong working ties to the state, holds an active NY MD or DO license, and brings leadership across clinical teams, networks, and payer collaborations to