Remote Medical Director - Quality & Utilization

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

Benefits offered by this job

Health insurance

401K plan

Stock purchase plan

Tuition reimbursement

Paid time off and holidays

Flexible work schedule

Job summary

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

You will provide medical leadership for utilization management, cost containment and quality improvement, perform medical reviews, and support performance initiatives while ensuring regulatory and accreditation compliance. Collaboration with clinical teams and provider networks is essential.

Qualifications

• MD/DO with active license; board-certified in a medical specialty preferred.
• Experience in utilization management and medical quality improvement.
• Active clinical practice is expected.
• Course work in health administration, health financing, insurance or personnel management is advantageous.
• Experience treating or managing care for a culturally diverse population.

Responsibilities

• Provide medical leadership for utilization management, cost containment and quality improvement.
• Perform medical reviews for utilization, quality assurance and complex cases.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve care quality and cost-effectiveness.
• Ensure compliance with regulatory, state, corporate and accreditation standards.
• Support physician committees and governance structures.
• Coordinate care for high-risk patients with care management teams.
• Collaborate with clinical teams, providers, appeals and consultants on complex cases.
• Participate in provider network development and market expansion if appropriate.
• Contribute to physician education on clinical issues and policies.
• Identify utilization review studies and monitor trends in medical service utilization.
• Identify quality improvement opportunities to reduce unwarranted variation.
• Interface with providers to implement recommendations to improve utilization and quality.
• Review claims for medical necessity and proper payment; develop provider alliances.
• Represent the unit before public bodies and state committees; may work weekends/holidays as needed.

Skills

Medical leadership

Utilization management

Quality improvement

Regulatory compliance

Collaboration with clinical teams

Education

Medical Doctor or DO

Utilization Management experience

Active medical practice

Health administration coursework

Experience with diverse populations

Job description

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

You will provide medical leadership for utilization management, cost containment and quality improvement, perform medical reviews, and support performance initiatives while ensuring regulatory and accreditation compliance. Collaboration with clinical teams and provider networks is essential.