Remote Medical Director: Quality & Utilization Leader

Centene Corporation; Nevada (IA); Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Corporation seeks a Medical Director-level professional to direct the medical management, quality improvement and credentialing functions for the business unit. You will provide medical leadership for utilization management, cost containment and quality improvement activities.

Responsibilities include conducting medical reviews, supporting performance improvement initiatives, and collaborating with clinical teams, providers and committees to enhance care quality and cost-effectiveness.

Qualifications

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Actively practices medicine.
• Course work in Health Administration, Health Financing or related areas is advantageous.
• Experience managing care for a culturally diverse population preferred.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing functions.
• Provide medical leadership for utilization management and medical quality improvement activities.
• Perform medical reviews for utilization review and quality assurance.
• Support performance improvement initiatives for capitated providers.
• Collaborate with clinical teams and provider networks to review complex cases and improve outcomes.

Skills

Medical leadership

Utilization management

Quality improvement

Clinical review

Communication skills

Education

MD or DO

Job description

Centene Corporation seeks a Medical Director-level professional to direct the medical management, quality improvement and credentialing functions for the business unit. You will provide medical leadership for utilization management, cost containment and quality improvement activities.

Responsibilities include conducting medical reviews, supporting performance improvement initiatives, and collaborating with clinical teams, providers and committees to enhance care quality and cost-effectiveness.