Remote Medical Director: Quality & Utilization Leader

Centene Corporation; Indiana; 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 plus holidays

Flexible work schedules (remote,Hybrid

Job summary

Centene Corporation seeks a Medical Director to lead utilization management, cost containment, and quality improvement across our health plans. The role involves medical reviews, policy planning, and ensuring compliance with accreditation standards.

The position requires MD/DO with active medical practice and experience in utilization management. Applicants should be prepared to engage with committees, provider networks, and performance-improvement initiatives while supporting a culturally

Qualifications

• MD/DO degree required and board-certified.
• Experience in utilization management and knowledge of accreditation standards.
• Active medical practice.
• Course work in health administration, financing, insurance or personnel management preferred.
• Experience caring for culturally diverse populations preferred.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical reviews for utilization review, quality assurance, and medical necessity.
• Support performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care.
• Represent the business unit on medical philosophy, policies, and related issues as needed.
• Conduct rounds to assess and coordinate care for high-risk patients.
• Collaborate with clinical teams and providers to review complex cases and appeals.

Education

Medical Doctor or Doctor of Osteopathy

Utilization Management experience

Quality accreditation standards knowledge

Actively practices medicine

Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management

Experience with culturally diverse populations

Job description

Centene Corporation seeks a Medical Director to lead utilization management, cost containment, and quality improvement across our health plans. The role involves medical reviews, policy planning, and ensuring compliance with accreditation standards.

The position requires MD/DO with active medical practice and experience in utilization management. Applicants should be prepared to engage with committees, provider networks, and performance-improvement initiatives while supporting a culturally