Pharmacy Medical Director: Quality & Utilization (Remote)

Centene Management Company LLC; Town of Florida (NY); Hybrid; USD 237,000 - 449,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible schedules: remote, hybrid, or

field or office work schedules

Job summary

Centene Management Company LLC is seeking a Medical Director to lead medical management, quality improvement, and credentialing for the unit. The role provides medical leadership for utilization management, cost containment and quality initiatives across numerous services.

The position requires an MD/DO with active licensure, board certification in a relevant specialty, and utilization management experience.

Qualifications

• Medical Doctor or Doctor of Osteopathy with active practice.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Experience treating or managing care for a culturally diverse population preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing functions.
• Provide medical leadership for utilization management, cost containment and medical quality improvement activities.
• Perform medical reviews for utilization review, quality assurance and complex or new/experimental services.
• Support performance improvement initiatives and regulatory compliance within the unit.
• Represent the business unit in state or national committees and collaborate with care management and provider networks.
• May require working weekends and holidays as needed.

Skills

Utilization management

Quality improvement

Provider collaboration

Education

Medical Doctor (MD) or Doctor of Osteopathy (DO)

Job description

Centene Management Company LLC is seeking a Medical Director to lead medical management, quality improvement, and credentialing for the unit. The role provides medical leadership for utilization management, cost containment and quality initiatives across numerous services.

The position requires an MD/DO with active licensure, board certification in a relevant specialty, and utilization management experience.