Pharmacy Medical Director: Quality & Utilization Leader

Centene Corp.; Northern (KY); Hybrid; USD 237,000 - 449,000; Full time

Job summary

Centene Corp. is seeking a Medical Director-level leader to guide medical management, quality improvement, and credentialing for the business unit in the United States.

The role provides medical leadership for utilization management, cost containment, and care quality while reviewing complex, controversial, or new services for medical necessity. The incumbent will collaborate with clinical teams, network providers, and committees, drive performance improvement initiatives, and participate in

Qualifications

• MD/DO board-certified; active medical license without restrictions.
• Experience in utilization management and quality accreditation standards.
• Experience treating diverse populations is preferred.

Responsibilities

• Direct medical management, quality improvement, and credentialing for the business unit.
• Lead utilization review and medical necessity determinations for complex cases.
• Collaborate with care management, network providers, and committees to improve outcomes.
• Support performance improvement initiatives and physician education.
• Represent the unit before state committees and public audiences as needed.

Skills

Utilization Management

Quality Improvement

Regulatory Compliance

Education

MD/DO

Job description

Centene Corp. is seeking a Medical Director-level leader to guide medical management, quality improvement, and credentialing for the business unit in the United States.

The role provides medical leadership for utilization management, cost containment, and care quality while reviewing complex, controversial, or new services for medical necessity. The incumbent will collaborate with clinical teams, network providers, and committees, drive performance improvement initiatives, and participate in