Remote Medical Director: Quality & Utilization Lead

Centene Corporation; Illinois; On-site; USD 237,000 - 449,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Job summary

Centene Corporation is seeking a Senior Medical Director to direct medical management, quality improvement, and credentialing for the business unit. You will provide medical leadership in utilization management, cost containment, and quality improvement activities, and review complex cases to ensure timely, quality decisions.

You will assist in planning goals and policies to improve care quality and cost-effectiveness, collaborate with clinical teams and providers, and participate in provider

Qualifications

• Medical Doctor or Doctor of Osteopathy required.
• 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 treating or managing care for a culturally diverse population preferred.

Responsibilities

• Assist the Chief Medical Director in directing medical management, quality improvement, and credentialing functions.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities for utilization review and quality assurance; ensure timely decisions.
• Support implementation of performance improvement initiatives for capitated providers.
• Coordinate goals and policies to improve quality and cost-effectiveness of care for members.
• Represent the business unit before state committees and other ad hoc groups as needed.
• Coordinate care for high-risk patients with care management teams to optimize outcomes.

Skills

Utilization management

Quality improvement

Medical leadership

Clinical experience

Diversity of population

Education

MD/DO degree

Health Administration coursework

Health Financing coursework

Job description

Centene Corporation is seeking a Senior Medical Director to direct medical management, quality improvement, and credentialing for the business unit. You will provide medical leadership in utilization management, cost containment, and quality improvement activities, and review complex cases to ensure timely, quality decisions.

You will assist in planning goals and policies to improve care quality and cost-effectiveness, collaborate with clinical teams and providers, and participate in provider