Remote Medical Director, Medicare Utilization & Quality

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

Benefits offered by this job

401K

Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules

Job summary

Centene Corporation is seeking a clinical leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the business unit. You will lead utilization management, drive cost containment and ensure high-quality care across networks.

The role requires a MD/DO with active board certification and ongoing medical practice, plus experience in accreditation standards and culturally diverse populations.

Qualifications

• Medical Doctor or Doctor of Osteopathy with active license.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Actively practices medicine.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous.
• Experience managing care for a culturally diverse population preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing functions for the business unit.
• Provide medical leadership for utilization management, cost containment, and quality improvement activities.
• Perform medical reviews for utilization, quality assurance, and complex or new services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care.

Skills

Utilization management

Quality improvement

Medical leadership

Provider collaboration

Education

Medical Doctor or Doctor of Osteopathy

Active board certification

Internal/Family Medicine board preferred

Job description

Centene Corporation is seeking a clinical leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the business unit. You will lead utilization management, drive cost containment and ensure high-quality care across networks.

The role requires a MD/DO with active board certification and ongoing medical practice, plus experience in accreditation standards and culturally diverse populations.