Remote Medical Director: Quality & Utilization Lead

Centene Corporation; Colorado; Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Flexible work arrangements

Job summary

Centene Corporation is seeking a senior physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role emphasizes medical leadership of utilization management, cost containment, and quality initiatives to improve care and cost-effectiveness.

Responsibilities include performing medical reviews, supporting performance improvement initiatives, and coordinating with clinical teams, providers, and

Qualifications

• MD or DO degree required and licensed without restrictions.
• Utilization Management experience and knowledge of accreditation standards preferred.
• Practices medicine actively as part of responsibilities.
• Course work in Health Administration, Health Financing, Insurance or Personnel Management is advantageous.
• Experience treating or managing care for culturally diverse populations preferred.

Responsibilities

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing.
• Provide medical leadership for utilization management, cost containment and quality improvement.
• Perform medical review activities for utilization review, QA, and complex services.
• Support implementation of performance improvements for capitated providers.
• Develop goals and policies to improve quality and cost-effectiveness of care for members.
• Represent the medical unit on committees and engage in provider network development.

Education

MD/DO

Utilization Management experience

Quality accreditation knowledge

Active medical practice

Health administration coursework

Care for diverse populations

Job description

Centene Corporation is seeking a senior physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role emphasizes medical leadership of utilization management, cost containment, and quality initiatives to improve care and cost-effectiveness.

Responsibilities include performing medical reviews, supporting performance improvement initiatives, and coordinating with clinical teams, providers, and