Remote Medical Director: Quality & Utilization Leader

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

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene is seeking a Chief Medical Director to lead medical management, quality improvement, and credentialing for the business unit. You will direct utilization management, cost containment, and ensure timely, high-quality medical decision making.

You will collaborate with care management teams, network providers, and specialty consultants to drive performance improvement, adhere to regulatory standards, and align physician education with clinical policies.

Qualifications

• Medical leadership across utilization management and quality improvement.
• Experience in utilization management and knowledge of quality accreditation standards is 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

• Direct and coordinate medical management, quality improvement, and credentialing functions for the business unit.
• Provide medical leadership of utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex or experimental services.
• Support performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning goals and policies to improve quality and cost-effectiveness of care.

Skills

Utilization management

Quality improvement

Clinical leadership

Regulatory compliance

Education

Medical Doctor or Doctor of Osteopathy

Board certification in a medical specialty recognized by ABMS/AOA

Certification in Internal or Family Medicine, preferred

Current state MD/DO license without restrictions

Job description

Centene is seeking a Chief Medical Director to lead medical management, quality improvement, and credentialing for the business unit. You will direct utilization management, cost containment, and ensure timely, high-quality medical decision making.

You will collaborate with care management teams, network providers, and specialty consultants to drive performance improvement, adhere to regulatory standards, and align physician education with clinical policies.