Remote Medical Director: Quality & Utilization Leader

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

Benefits offered by this job

Comprehensive benefits

Tuition reimbursement

401K and stock plans

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Corporation 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 provide medical leadership for utilization management, cost containment, and quality initiatives, perform reviews on complex cases, and support performance improvements for capitated providers.

You will collaborate with clinical teams, network providers, and consultants to ensure medical necessity, implement

Qualifications

• MD or DO degree required.
• Board certification in a medical specialty preferred.
• Current state license without restrictions or sanctions.

Responsibilities

• Lead medical management, quality improvement, and credentialing initiatives.
• Perform medical reviews for utilization, QA, and complex or new services.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams and providers to review cases and ensure medical necessity.
• Develop and implement physician education on clinical issues and policies.

Skills

Utilization Management

Quality Improvement

Medical Review

Education

MD or DO

Board Certification

Job description

Centene Corporation 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 provide medical leadership for utilization management, cost containment, and quality initiatives, perform reviews on complex cases, and support performance improvements for capitated providers.

You will collaborate with clinical teams, network providers, and consultants to ensure medical necessity, implement