Remote Behavioral Health Medical Director — Quality & Utilization

Centene Corporation; Missouri; Remote; USD 215,000 - 409,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off and holidays

Flexible remote/hybrid work options

Job summary

Centene Corporation seeks a Psychiatrist to serve as Behavioral Health Medical Director in a fully remote capacity across the United States. You will guide medical management, utilization, quality improvement, and credentialing, collaborating with multidisciplinary teams to optimize member care.

Board-certified psychiatry and an unrestricted state license are required, with experience in utilization management and accreditation standards highly valued.

Qualifications

• Board certification in psychiatry is required.
• Current state medical license (MD or DO) without restrictions.
• Experience with Utilization Management and quality accreditation standards is preferred.

Responsibilities

• Provides medical leadership for utilization management, cost containment, and medical quality improvement.
• Performs medical reviews for utilization and quality assurance to ensure timely, high-quality decisions.
• Supports performance improvement initiatives for capitated providers.
• Assists in planning goals and policies to improve care quality and cost-effectiveness.
• Represents the physician committees and contributes to committee processes and membership.
• Conducts rounds to coordinate care for high-risk patients with care management teams.
• Collaborates with clinical teams, network providers, and consultants on complex cases and medical necessity appeals.
• Participates in provider network development and market expansion.
• Assists in physician education on clinical issues and policies.
• Identifies utilization review studies and adverse trends to reduce unwarranted variation.

Job description

Centene Corporation seeks a Psychiatrist to serve as Behavioral Health Medical Director in a fully remote capacity across the United States. You will guide medical management, utilization, quality improvement, and credentialing, collaborating with multidisciplinary teams to optimize member care.

Board-certified psychiatry and an unrestricted state license are required, with experience in utilization management and accreditation standards highly valued.