Remote Medical Director - Quality & Utilization Leader

Centene; United States; Hybrid; USD 237,000 - 449,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements (remote,hyb

Job summary

Centene is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role emphasizes medical leadership in utilization management, review of complex cases, and advancing performance improvement initiatives.

The position requires an MD/DO, board certification, and active medical practice, with experience in utilization management and diverse patient populations.

Qualifications

• Medical license in MD or DO without restrictions.
• Board certification in a medical specialty.
• Utilization management experience and knowledge of quality accreditation standards.
• Active medical practice.
• Experience treating or managing care for a culturally diverse population.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement.
• Perform medical reviews for utilization review and quality assurance.
• Coordinate care for high-risk patients with care management teams.
• Collaborate with clinical teams, providers, and consultants on complex cases and medical necessity appeals.
• Represent the business unit on state and national committees and initiatives.

Education

Medical Doctor (MD) or Doctor of Osteopathy (DO)

Health Administration / Health Financing coursework

Job description

Centene is seeking a physician leader to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. The role emphasizes medical leadership in utilization management, review of complex cases, and advancing performance improvement initiatives.

The position requires an MD/DO, board certification, and active medical practice, with experience in utilization management and diverse patient populations.