Remote Medical Director: Lead Quality & Utilization

Centene Management Company LLC; Missouri; Hybrid; USD 237,000 - 449,000; Full time

Job summary

Centene is seeking medical leadership to direct and coordinate medical management, quality improvement and credentialing for the business unit. Assist the Chief Medical Director in utilizing management activities, clinical quality initiatives and regulatory compliance to improve care for members.

Requires Medical Doctor or Doctor of Osteopathy, board certification in a specialty (Internal or Family Medicine preferred) and an active license.

Qualifications

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services. Certification in Internal or Family Medicine, preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing.
• Provide medical leadership for utilization management and quality improvement.
• Review claims involving complex or unusual or new services to determine medical necessity and appropriate payment.
• Represent the business unit before state committees and other ad hoc committees.
• May be required to work weekends and holidays in support of business operations, as needed.

Skills

Utilization Management experience

Quality improvement

Medical leadership

Clinical collaboration

Education

MD/DO

Job description

Centene is seeking medical leadership to direct and coordinate medical management, quality improvement and credentialing for the business unit. Assist the Chief Medical Director in utilizing management activities, clinical quality initiatives and regulatory compliance to improve care for members.

Requires Medical Doctor or Doctor of Osteopathy, board certification in a specialty (Internal or Family Medicine preferred) and an active license.