Remote Medical Director - Quality & Utilization Leader

Centene Corporation; Nebraska; Hybrid; USD 236,500 - 449,300; 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

Office/field/work flexibility

Job summary

Centene Corporation is seeking a clinical professional for Medical Management/Health Services to lead utilization management, quality improvement, and medical reviews for a large member population. The role involves collaborating with care teams, providers, and committees to ensure high-quality, cost-effective care.

Requirements include an MD or DO with active practice and board certification in a medical specialty.

Qualifications

• MD or DO with licensure in good standing
• Board-certified or eligible in a medical specialty
• Experience in utilization management and quality accreditation preferred
• Experience treating diverse populations preferred

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical review related to utilization review, quality assurance, and complex services.
• Support performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning goals and policies to improve care quality and cost-effectiveness.
• Represent the medical unit in physician committees and public forums as needed.
• Coordinate care for high-risk patients with care management teams to optimize outcomes.
• Collaborate with clinical teams, providers, and consultants on complex cases and appeals.
• Contribute to provider network development and market expansion.

Skills

Utilization Management

Quality accreditation knowledge

Active medical practice

Care for diverse populations

Education

Medical Doctor or Doctor of Osteopathy

Board certification in a medical specialty

Internal or Family Medicine certification

Current MD/DO license

Job description

Centene Corporation is seeking a clinical professional for Medical Management/Health Services to lead utilization management, quality improvement, and medical reviews for a large member population. The role involves collaborating with care teams, providers, and committees to ensure high-quality, cost-effective care.

Requirements include an MD or DO with active practice and board certification in a medical specialty.