Remote Medical Director - Quality & Utilization Leader

Centene Corporation; Missouri; 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 + holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Medical Director to lead medical management, utilization review, and quality improvement for the business unit. This role coordinates credentialing, provider networks, and clinical education to support high-quality, cost-effective care.

Responsibilities include medical review, care-management coordination, and representation in policy discussions. Board-certified physicians with active practice are preferred.

Qualifications

• MD/DO degree and active medical license.
• 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 managing care for a culturally diverse population preferred.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical review activities pertaining to utilization review and quality assurance.
• 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 approved quality improvement and utilization management programs.
• Assist in physician committee functioning, structure, processes, and membership.
• Coordinate rounds to assess and coordinate care for high-risk patients with care management teams.
• Collaborate with clinical teams and providers for complex case reviews and medical necessity appeals.
• Participate in provider network development and new market expansion as appropriate.
• Develop and implement physician education on clinical issues and policies.
• Identify utilization review studies and evaluate adverse trends in utilization.

Skills

Utilization management

Quality improvement

Medical leadership

Care management

Provider relations

Clinical operations

Education

MD/DO

Board certification in medical specialty

Job description

Centene Corporation seeks a Medical Director to lead medical management, utilization review, and quality improvement for the business unit. This role coordinates credentialing, provider networks, and clinical education to support high-quality, cost-effective care.

Responsibilities include medical review, care-management coordination, and representation in policy discussions. Board-certified physicians with active practice are preferred.