Medical Director, Quality & Utilization Leadership

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

PTO and holidays

Flexible work arrangement

Job summary

Centene Management Company LLC is seeking a Board-certified physician to support the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role requires NY licensure and active clinical practice, with leadership across utilization review and performance improvement initiatives.

The candidate will coordinate with clinical teams, network providers, and committees to ensure high-quality, cost-effective care for members, including

Qualifications

• Board certification in a medical specialty recognized by ABMS or AOA.
• Active New York medical license (MD or DO) with no restrictions.
• Experience in utilization management and accreditation standards preferred.

Responsibilities

• Assist the Chief Medical Director in directing medical management, quality improvement, and credentialing.
• Provide medical leadership for utilization management, cost containment, and quality initiatives.
• Review complex or new medical services for medical necessity and payment.
• Collaborate with care teams and provider network for program implementation.

Skills

Utilization management leadership

Quality improvement

Clinical leadership

Interdisciplinary coordination

Education

MD or DO

Job description

Centene Management Company LLC is seeking a Board-certified physician to support the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role requires NY licensure and active clinical practice, with leadership across utilization review and performance improvement initiatives.

The candidate will coordinate with clinical teams, network providers, and committees to ensure high-quality, cost-effective care for members, including