Remote Medical Director - Health Services & Quality

Centene Corporation; Colorado; Hybrid; USD 237,000 - 449,000; Full time

Benefits offered by this job

Health insurance

401K & stock plans

Tuition reimbursement

Paid time off

Flexible schedule (remote/hybrid/onsit

Job summary

Centene Corporation seeks a clinical leader to steer medical management and utilization management activities for our 28 million members. You will provide medical leadership, perform utilization reviews, and drive quality improvement across networks and services.

Collaborating with care management teams, providers, and committees, you will help set goals, policies, and education on clinical issues, ensuring high-quality, cost-effective care while aligning with regulatory and accreditation

Qualifications

• MD/DO with active license is required.
• Utilization management experience and accreditation knowledge preferred.
• Experience serving diverse patient populations.

Responsibilities

• Provide medical leadership of utilization management, cost containment, and quality improvement activities.
• Perform medical review activities for utilization review, quality assurance, and reviews of complex or novel services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness.
• Provide medical expertise for approved quality improvement and utilization programs.
• Participate in physician committee functioning and education.
• Coordinate care for high-risk patients with care management teams to improve outcomes.
• Collaborate with clinical teams, providers, and consultants on complex cases and appeals.
• Contribute to provider network development and market expansion as appropriate.
• Identify utilization review studies and monitor adverse utilization trends.
• Identify quality improvement studies to reduce unwarranted variation in practice.
• Represent the business unit before publics on medical philosophy and policies.
• May work weekends/holidays as needed.

Skills

Utilization management

Quality improvement

Medical leadership

Healthcare coordination

Education

MD/DO

Job description

Centene Corporation seeks a clinical leader to steer medical management and utilization management activities for our 28 million members. You will provide medical leadership, perform utilization reviews, and drive quality improvement across networks and services.

Collaborating with care management teams, providers, and committees, you will help set goals, policies, and education on clinical issues, ensuring high-quality, cost-effective care while aligning with regulatory and accreditation