Regional Medical Director, Utilization & Quality

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation seeks a physician leader to guide utilization management, quality improvement, and medical review across networks. The role supports cost-containment and patient care excellence while aligning with regulatory and accreditation standards.

The position emphasizes collaboration with clinical teams, provider networks, and committees to optimize outcomes and ensure appropriate payment for complex services.

Qualifications

• Medical Doctor or Doctor of Osteopathy; board-certified or eligible.
• Utilization management experience and knowledge of accreditation standards preferred.
• Active medical practice with clinical engagement.
• Course work in health administration, financing, insurance, or personnel management is advantageous.
• Experience caring for diverse patient populations.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement activities.
• Lead medical review activities for utilization review, quality assurance, and complex services.
• Support performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning goals, policies, and cost-effective care strategies.
• Ensure compliance with regulatory, state, corporate, and accreditation requirements.
• Collaborate with physician committees and care teams to optimize outcomes.
• Review complex or unusual medical services to determine necessity and payment.
• Develop alliances with the provider community through medical management programs.

Skills

Utilization management

Quality accreditation standards

Active medical practice

Healthcare administration knowledge

Experience with diverse populations

Education

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

Course work in Health Administration/Financing/Insurance/Personnel Management

Job description

Centene Corporation seeks a physician leader to guide utilization management, quality improvement, and medical review across networks. The role supports cost-containment and patient care excellence while aligning with regulatory and accreditation standards.

The position emphasizes collaboration with clinical teams, provider networks, and committees to optimize outcomes and ensure appropriate payment for complex services.