Remote Medical Director - Quality & Utilization Leader

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

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off & holidays

Flexible work schedules

Job summary

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the business unit. You will lead utilization management activities and medical reviews, ensuring timely and high-quality decisions, while supporting performance improvement for capitated providers.

The role includes planning goals, implementing policies to improve care quality and cost-effectiveness, and collaborating with clinical

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, 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 and quality improvement.
• Perform medical reviews of complex services ensuring timely decisions.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness.
• Review claims to determine medical necessity and payment.
• Develop alliances with the provider community through medical management programs.
• Represent the unit before state committees when required.

Skills

Utilization Management experience

Active medical practice

Cultural diversity experience

Education

MD or DO

Job description

Centene Corporation is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for the business unit. You will lead utilization management activities and medical reviews, ensuring timely and high-quality decisions, while supporting performance improvement for capitated providers.

The role includes planning goals, implementing policies to improve care quality and cost-effectiveness, and collaborating with clinical