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,hyb

Job summary

Centene Corporation seeks a physician leader to direct medical management, quality improvement and credentialing for the business unit. Lead utilization management, medical reviews, and performance-improvement initiatives to enhance cost-effectiveness and care quality.

The role involves collaboration with clinical teams, network providers and committees, with potential weekend/holiday support and national representation on medical policy issues.

Qualifications

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Active practice of medicine.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing for the business unit.
• Provide medical leadership for utilization management and quality improvement activities.
• Perform medical reviews for utilization review and quality assurance to ensure timely decisions.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness.

Skills

Medical leadership

Clinical quality improvement

Utilization management

Education

Medical Doctor or Doctor of Osteopathy

Board certification in internal or family medicine

Board certification in a medical specialty

Current state MD/DO license

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

Job description

Centene Corporation seeks a physician leader to direct medical management, quality improvement and credentialing for the business unit. Lead utilization management, medical reviews, and performance-improvement initiatives to enhance cost-effectiveness and care quality.

The role involves collaboration with clinical teams, network providers and committees, with potential weekend/holiday support and national representation on medical policy issues.