National Medical Director — Utilization & Quality

Centene Corp.; Missouri; Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Health insurance

401(k) and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote/hybrid

Office/field work options

Job summary

Centene Corp. seeks a Medical Director to provide leadership in utilization management, quality improvement, and cost containment. You will review complex cases, contribute to policy development, and work with providers and committees to ensure medical necessity and cost-effective care.

The role requires active medical practice, board certification, and licensure in good standing. Experience across diverse populations and knowledge of accreditation standards are highly valued.

Qualifications

• 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

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical review for utilization review, quality assurance, and medical review of complex or experimental services.
• Support performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning goals and policies to improve quality and cost-effectiveness of care.
• Review claims involving complex, controversial, or unusual services to determine medical necessity and payment.

Skills

Utilization Management experience

Quality accreditation knowledge

Active medical practice

Culturally diverse population exposure

Education

Medical Doctor or Doctor of Osteopathy

Board certification in a medical specialty (ABMS/AOA)

Internal or Family Medicine certification

Current state MD/DO license

Job description

Centene Corp. seeks a Medical Director to provide leadership in utilization management, quality improvement, and cost containment. You will review complex cases, contribute to policy development, and work with providers and committees to ensure medical necessity and cost-effective care.

The role requires active medical practice, board certification, and licensure in good standing. Experience across diverse populations and knowledge of accreditation standards are highly valued.