Remote Medical Director - Quality & Utilization Leader

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

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene Corporation is seeking a physician leader to oversee utilization management, quality improvement, and medical review across programs. You will guide medical policy, supervise complex case reviews, and support performance initiatives to optimize cost and care quality.

A board-certified MD/DO with active license and UR experience is preferred. The role requires collaboration with care teams, providers, and committees, with flexible work arrangements including remote and hybrid options.

Qualifications

• MD or DO with medical licensure in good standing.
• Board certification in a specialty recognized by ABMS or AOA.
• Utilization management experience and knowledge of quality accreditation standards preferred.
• Active medical practice and understanding of healthcare delivery and financing are advantageous.
• Experience managing care for culturally diverse populations preferred.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement activities.
• Perform medical reviews for utilization review, quality assurance, and complex or experimental services.
• Support performance improvement initiatives for capitated providers.
• Plan and help set goals to improve quality and cost-effectiveness of care for members.
• Lead in running physician education on clinical issues and policies.
• Review complex claims to determine medical necessity and proper payment.
• Collaborate with clinical teams, providers, appeals teams, and consultants on complex cases.
• Represent the business unit at state and national committees as needed.

Skills

Utilization management

Quality improvement

Medical leadership

Regulatory compliance

Stakeholder collaboration

Education

MD/DO

Board certification (medical)

Job description

Centene Corporation is seeking a physician leader to oversee utilization management, quality improvement, and medical review across programs. You will guide medical policy, supervise complex case reviews, and support performance initiatives to optimize cost and care quality.

A board-certified MD/DO with active license and UR experience is preferred. The role requires collaboration with care teams, providers, and committees, with flexible work arrangements including remote and hybrid options.