Remote Medical Director: Quality & Utilization Leader

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work arrangements (remote,hyb

Flexible work arrangements (remote,hyb

Job summary

Centene Corporation is seeking an experienced physician leader to guide medical management, quality improvement and credentialing for the business unit. You will provide medical leadership for utilization management, cost containment and care quality initiatives across the network.

You will perform medical reviews, support performance improvement, and plan strategies to improve outcomes and cost-effectiveness for members.

Qualifications

• MD/DO degree and board certification in a medical specialty.
• Active medical practice is required.
• Utilization management experience is preferred.
• Experience with diverse patient populations is preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing.
• Provide medical leadership for utilization management and quality improvement activities.
• Perform medical reviews for utilization review and quality assurance.
• Support performance improvement initiatives for capitated providers.
• Plan and establish goals to improve quality and cost-effectiveness of care.
• Operate quality improvement and utilization management programs per regulations.
• Manage physician committees and governance structures.
• Conduct rounds to assess care for high-risk patients with care teams.
• Collaborate with clinical teams, providers, appeals and consultants on complex cases.
• Participate in provider network development and market expansion.
• Develop physician education on clinical issues and policies.
• Identify utilization review studies and detect adverse trends.
• Identify quality improvement studies to reduce unwarranted variation.
• Interface with physicians to implement care improvements.
• Review claims for medical necessity and appropriate payment.
• Build alliances with provider community for medical management programs.
• Represent the unit before publics and committees as needed.

Skills

Utilization Management

Quality accreditation standards

Active medical practice

Cultural diversity experience

Education

MD or DO

Board certification in a medical specialty

Current state MD/DO license

Job description

Centene Corporation is seeking an experienced physician leader to guide medical management, quality improvement and credentialing for the business unit. You will provide medical leadership for utilization management, cost containment and care quality initiatives across the network.

You will perform medical reviews, support performance improvement, and plan strategies to improve outcomes and cost-effectiveness for members.