Remote Behavioral Medical Director: Clinical Leadership

Centene Corporation; Nebraska; Hybrid; USD 236,500 - 449,300; Full time

Job summary

Centene Corporation seeks a clinical leader to direct medical management, quality improvement, and credentialing for the Medical Management/Health Services team. The role supports utilization management, cost containment, and physician collaboration to improve member care.

The ideal candidate is a licensed MD/DO with board certification and experience in utilization management, QA, and regulatory compliance, with flexibility for remote or hybrid work arrangements.

Qualifications

• MD or DO with active license and board certification in psychiatry or neurology.
• Utilization management experience and QA knowledge preferred.
• Experience treating diverse patient populations is advantageous.

Responsibilities

• Direct medical management, quality improvement, and credentialing activities.
• Lead utilization management, cost containment, and quality initiatives.
• Perform medical reviews for utilization and complex cases.
• Support performance improvement for capitated providers.
• Plan goals and policies to improve quality and cost-effectiveness.
• Ensure regulatory and accreditation compliance.
• Participate in physician committees and advisory processes.
• Conduct rounds for high-risk patients with care teams.
• Collaborate with clinical teams and providers on reviews and appeals.
• Develop provider networks and participate in market expansion.
• Educate physicians on clinical issues and policies.
• Identify studies to address utilization trends and variation.
• Review complex or unusual claims for medical necessity.
• Represent the unit on state committees and public forums.
• May work weekends/holidays as needed.

Skills

Medical Leadership

Utilization Management

Quality Improvement

Collaboration

Clinical Decision Making

Education

MD/DO

Job description

Centene Corporation seeks a clinical leader to direct medical management, quality improvement, and credentialing for the Medical Management/Health Services team. The role supports utilization management, cost containment, and physician collaboration to improve member care.

The ideal candidate is a licensed MD/DO with board certification and experience in utilization management, QA, and regulatory compliance, with flexibility for remote or hybrid work arrangements.