Remote Behavioral Medical Director — Quality & Utilization Leader

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

Job summary

Centene Corporation is seeking a clinical leader to assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing. The role provides medical leadership for utilization management, cost containment, and quality improvement activities, ensuring timely and quality decision making.

You will support performance improvement initiatives, review complex medical cases, and collaborate with care management teams and provider networks to improve

Qualifications

• MD/DO with active license and board certification in psychiatry.
• Utilization management experience and knowledge of quality accreditation standards preferred.
• Course work in health administration, health financing, insurance, or personnel management is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement, and credentialing for the business unit.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Review and approve medical necessity, complex cases, and appeals with timely decision making.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams, provider networks, appeals team, and consultants on complex cases.
• Develop physician education on clinical issues and policies and participate in committees.

Skills

Utilization management

Education

MD/DO

ABPN board certification

State license (MD/DO)

Health administration coursework

Experience with diverse populations

Job description

Centene Corporation is seeking a clinical leader to assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing. The role provides medical leadership for utilization management, cost containment, and quality improvement activities, ensuring timely and quality decision making.

You will support performance improvement initiatives, review complex medical cases, and collaborate with care management teams and provider networks to improve