Remote Medical Director: Quality & Utilization Leader

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

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote,Hybrid

Job summary

Centene Corp. is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

The role provides medical leadership for utilization management, cost containment, and quality initiatives across programs. Responsibilities include medical reviews for complex cases, supporting performance improvement, and collaborating with care management teams and providers to improve outcomes and efficiency.

Qualifications

• Board certification in a medical specialty recognized by the ABMS or the AOA.
• Certification in Internal or Family Medicine preferred.
• Current state MD or DO license without restrictions, limitations, or sanctions.

Responsibilities

• Assist the Chief Medical Director in directing medical management, quality improvement, and credentialing.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical reviews to determine medical necessity and appropriate payment for complex or controversial services.
• Support performance improvement initiatives for capitated providers.
• Plan and implement physician education on clinical issues and policies.

Education

Medical Doctor or Doctor of Osteopathy

Health Administration/Financing/Insurance/Personnel Management coursework

Experience with culturally diverse populations

Job description

Centene Corp. is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit.

The role provides medical leadership for utilization management, cost containment, and quality initiatives across programs. Responsibilities include medical reviews for complex cases, supporting performance improvement, and collaborating with care management teams and providers to improve outcomes and efficiency.