Remote Medical Director: Quality & Utilization Leader

Centene Corporation; Iowa; 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 and holidays

Flexible work schedules

Job summary

Centene Corporation is seeking a Medical Director-level professional to lead medical management, quality improvement, and credentialing for the business unit in the United States. The role involves directing utilization management, performing complex medical reviews, and guiding performance initiatives to improve care quality and cost-effectiveness.

Requirements include MD/DO with board certification, active medical practice, and experience in utilization management with knowledge of

Qualifications

• MD or DO with board certification in a medical specialty.
• Utilization Management experience; knowledge of quality accreditation standards.
• Active medical practice is required.
• Course work in Health Administration, Health Financing, Insurance and/or Personnel Management is advantageous.
• Experience caring for diverse populations.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and medical quality improvement.
• Perform medical reviews for utilization review, quality assurance, and complex services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness of care.
• Engage in medical management programs compliant with regulatory and accreditation standards.
• Represent the business unit on medical philosophy and policy at committees as needed.

Skills

Utilization Management

Quality improvement

Medical leadership

Communication

Health administration

Education

MD/DO (Medical Doctor or Osteopathy)

Health Administration coursework

Tools

Board certification

Internal/Family Medicine certification

Job description

Centene Corporation is seeking a Medical Director-level professional to lead medical management, quality improvement, and credentialing for the business unit in the United States. The role involves directing utilization management, performing complex medical reviews, and guiding performance initiatives to improve care quality and cost-effectiveness.

Requirements include MD/DO with board certification, active medical practice, and experience in utilization management with knowledge of