Remote Medical Director: Quality & Utilization Leader

Centene Corporation; Nebraska; Hybrid; USD 215.000 - 409.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote/hybrid

Zusammenfassung

Centene Corporation is seeking a medical leader to coordinate medical management, quality improvement, and credentialing for the business unit. You will guide utilization management, participate in complex case reviews, and work with care teams to optimize outcomes across the network.

The role requires MD/DO credentials, experience in utilization management, and familiarity with accreditation standards. The company emphasizes clinician collaboration, improved patient outcomes, and a flexible

Qualifikationen

• MD or DO degree and board eligibility/recertification preferred.
• Utilization management experience and knowledge of quality accreditation standards preferred.
• Actively practices medicine and engages in professional development.
• Course work in Health Administration/Financing/Insurance is advantageous.
• Experience caring for culturally diverse populations preferred.

Aufgaben

• Assist CMDirector with directing medical management, quality improvement, and credentialing functions.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities related to utilization review, QA, and complex cases for timely decisions.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve care quality and cost-effectiveness.
• Contribute to physician education on clinical issues and policies.
• Review complex claims to determine medical necessity and payment.
• Develop alliances with the provider community to implement medical management programs.

Kenntnisse

Utilization management

Quality improvement

Ausbildung

MD/DO

Jobbeschreibung

Centene Corporation is seeking a medical leader to coordinate medical management, quality improvement, and credentialing for the business unit. You will guide utilization management, participate in complex case reviews, and work with care teams to optimize outcomes across the network.

The role requires MD/DO credentials, experience in utilization management, and familiarity with accreditation standards. The company emphasizes clinician collaboration, improved patient outcomes, and a flexible