Remote Medical Director – Quality & Utilization Leader

Centene Corp.; Nebraska; Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote/Hybrid/Field/Office work models

Job summary

Centene Corp. seeks a physician leader to direct and coordinate medical management, quality improvement, and credentialing within the business unit.

You will provide medical leadership for utilization management, cost containment, and high-quality patient care. The role involves medical reviews, adherence to accreditation standards, and collaboration with care teams to optimize outcomes and healthcare delivery.

Qualifications

• Medical Doctor or Doctor of Osteopathy required.
• 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 treating or managing care for a culturally diverse population preferred.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical reviews for utilization review, quality assurance, and complex services.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness.
• Lead physician education on clinical issues and policies.
• Review complex claims to determine medical necessity and payment.

Skills

Medical leadership

Utilization management

Quality improvement

Clinical collaboration

Regulatory knowledge

Medical review

Interdisciplinary coordination

Education

MD/DO

Health administration coursework

Culturally diverse care experience

Job description

Centene Corp. seeks a physician leader to direct and coordinate medical management, quality improvement, and credentialing within the business unit.

You will provide medical leadership for utilization management, cost containment, and high-quality patient care. The role involves medical reviews, adherence to accreditation standards, and collaboration with care teams to optimize outcomes and healthcare delivery.