Remote Director of Medical Quality & Utilization

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

Benefits offered by this job

Health insurance

401(k) plan

Stock purchase plan

Tuition reimbursement

Paid time off & holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

Responsibilities include medical leadership for utilization management, cost containment, and quality improvement activities, plus reviewing complex cases and supporting performance improvements across networks. The role involves collaboration with care management teams and external providers to enhance outcomes.

Qualifications

• Medical degree and active medical license.
• Experience with utilization management and quality accreditation standards.
• Active medical practice and familiarity with health care delivery systems.

Responsibilities

• Provide leadership for utilization management, cost containment, and medical quality improvement.
• Perform medical reviews for utilization review, quality assurance, and complex cases.
• Support performance improvement initiatives and credentialing activities for the business unit.
• Assist in physician education and policy development to improve care quality and cost-effectiveness.
• Coordinate with care management, network providers, and consultants on complex cases and appeals.

Skills

Medical leadership

Utilization management

Quality improvement

Medical review

Collaboration

Education

MD/DO degree

Job description

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

Responsibilities include medical leadership for utilization management, cost containment, and quality improvement activities, plus reviewing complex cases and supporting performance improvements across networks. The role involves collaboration with care management teams and external providers to enhance outcomes.