Medical Director: Quality & Utilization Leader (Remote)

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

Job summary

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. You will lead utilization management, cost containment, and medical quality initiatives across network providers.

Active medical practice is required, with board certification and licensure. The role requires collaboration with clinical teams, participation in physician committees, and engagement with regulatory

Qualifications

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Actively practices medicine.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Responsibilities

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing.
• Provide medical leadership for utilization management, cost containment and quality improvement.
• Perform medical reviews related to utilization review, QA and complex/experimental services.
• Support performance improvement initiatives for capitated providers.
• Plan and establish goals to improve quality and cost-effectiveness of care for members.
• Ensure compliance with regulatory, state, corporate and accreditation requirements.
• Collaborate with physician committees, networks and support review appeals.
• Coordinate care for high-risk patients with care management teams to optimize outcomes.
• Represent the business unit at state and national committees as needed.

Skills

Utilization management

Quality improvement

Medical leadership

Clinical review

Physician collaboration

Education

MD/DO

Board certification

Active state license

Internal/Family Medicine preferred

Health administration exposure

Job description

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. You will lead utilization management, cost containment, and medical quality initiatives across network providers.

Active medical practice is required, with board certification and licensure. The role requires collaboration with clinical teams, participation in physician committees, and engagement with regulatory