Remote Medical Director, Pharmacy & Quality Improvement

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

Benefits offered by this job

Health Insurance

401K and Stock Purchase Plans

Tuition Reimbursement

Paid Time Off & Holidays

Flexible work schedules

Job summary

Centene Corporation in the United States is seeking a physician-leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the business unit. You will oversee utilization management, cost containment and medical quality initiatives, and review complex cases for medical necessity to ensure optimal patient outcomes.

This role involves collaboration with care teams, reviewers and network providers, and may require representing the unit at

Qualifications

• 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 is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Responsibilities

• Lead utilization management, cost containment, and medical quality improvement activities.
• Review complex or new medical services for medical necessity and payment.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams and providers to optimize care outcomes.

Skills

Utilization management

Medical leadership

Clinical coordination

Education

Medical Doctor or Doctor of Osteopathy

Job description

Centene Corporation in the United States is seeking a physician-leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the business unit. You will oversee utilization management, cost containment and medical quality initiatives, and review complex cases for medical necessity to ensure optimal patient outcomes.

This role involves collaboration with care teams, reviewers and network providers, and may require representing the unit at