Remote Medical Director: Quality & Utilization Leader

Centene Corporation; Missouri; Hybrid; USD 237,000 - 449,000; 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,hy‑

Flexible work arrangements (remote,hy‑

Job summary

Centene Corporation is seeking a physician leader to oversee utilization management, cost containment, and medical quality improvement activities. You will perform medical reviews for complex services and support performance initiatives for capitated providers.

Collaborate with clinical teams, networks, and appeals departments to ensure quality and appropriate payment. The role requires MD/DO licensure, board certification, and active medical practice, with opportunities to develop provider

Qualifications

• Medical Doctor or Doctor of Osteopathy with licensure in good standing.
• Utilization Management experience and knowledge of accreditation standards.
• Active medical practice and ongoing clinical involvement.
• Training in health administration, financing, insurance, or personnel management is advantageous.
• Experience serving culturally diverse patient populations.

Responsibilities

• Provides medical leadership for utilization management and quality improvement.
• Performs medical reviews for utilization review, QA, and complex or experimental services.
• Supports performance improvement initiatives for capitated providers.
• Plans goals and policies to improve quality and cost-effectiveness of care.
• Represents medical philosophy and policies to publics and committees as needed.
• Coordinates care for high-risk patients with care management teams.
• Collaborates with clinical teams, providers, appeals and consultants on complex cases.
• Develops provider education on clinical issues and policies.
• Reviews claims to determine medical necessity and payment adequacy.
• Engages in provider network development and market expansion.

Skills

Utilization management leadership

Medical review & quality improvement

Collaboration with clinical teams

Regulatory knowledge

Education

Medical Doctor or Doctor of Osteopathy

Utilization Management experience

Course work in Health Administration/Health Financing/Insurance/Personnel Management

Experience treating diverse populations

Current state MD/DO license

Board certification in a medical specialty

Certification in Internal or Family Medicine (preferred)

Job description

Centene Corporation is seeking a physician leader to oversee utilization management, cost containment, and medical quality improvement activities. You will perform medical reviews for complex services and support performance initiatives for capitated providers.

Collaborate with clinical teams, networks, and appeals departments to ensure quality and appropriate payment. The role requires MD/DO licensure, board certification, and active medical practice, with opportunities to develop provider