Remote Medical Director: Quality & Utilization Leader

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements (remote,hyb

Job summary

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the unit. This role provides medical leadership for utilization management, cost containment, and quality initiatives to improve member care.

Responsibilities include reviewing complex cases for medical necessity, supporting performance improvement initiatives, and collaborating with clinical teams, providers, and committees.

Qualifications

• MD/DO with licensure to practice in the United States.
• Experience in utilization management and quality accreditation standards.
• Active practice of medicine with ability to review complex cases.

Responsibilities

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions for the business unit.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical reviews for utilization review and quality assurance to ensure timely decisions.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care for members.
• Provide medical expertise in quality improvement and utilization management programs per regulatory and accreditation requirements.
• Collaborate with physician committees, care management teams, and providers for complex cases and appeals.
• Participate in provider network development and new market expansion as appropriate.
• Develop physician education on clinical issues and policies.

Education

Medical Doctor or Doctor of Osteopathy

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 is advantageous

Experience treating or managing care for a culturally diverse population preferred

Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services

Active Certification in Internal or Family Medicine, preferred

Current state license as a MD or DO without restrictions

Job description

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the unit. This role provides medical leadership for utilization management, cost containment, and quality initiatives to improve member care.

Responsibilities include reviewing complex cases for medical necessity, supporting performance improvement initiatives, and collaborating with clinical teams, providers, and committees.