Remote Medical Director: Quality & Utilization Leader

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

Job summary

Centene Corporation seeks a Medical Director to lead medical management, quality improvement and credentialing for the business unit. You will oversee utilization management, ensure timely reviews of complex services, and collaborate with clinical teams to optimize outcomes and cost-effectiveness.

Requirements include MD/DO with board certification and an active state license; prior utilization management and accreditation experience is preferred.

Qualifications

• MD or DO degree required and active medical license.
• Board certification in a medical specialty recognized by major boards.
• Experience in utilization management and quality accreditation standards.
• Leadership experience in medical management and provider networks.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing for the business unit.
• Provide medical leadership for utilization management, cost containment and quality improvement activities.
• Review complex or unusual medical services for medical necessity and appropriate payment.
• Lead performance improvement initiatives across capitated providers and networks.
• Collaborate with clinical teams, providers, appeals and consultants to review cases and improve outcomes.
• Represent the unit on state committees and professional forums as needed.

Skills

Utilization management

Quality improvement

Medical leadership

Care coordination

Education

MD/DO degree

Board certification in medical specialty

Internal or Family Medicine certification

Active state medical license

Job description

Centene Corporation seeks a Medical Director to lead medical management, quality improvement and credentialing for the business unit. You will oversee utilization management, ensure timely reviews of complex services, and collaborate with clinical teams to optimize outcomes and cost-effectiveness.

Requirements include MD/DO with board certification and an active state license; prior utilization management and accreditation experience is preferred.