Remote Medical Director: Quality & Utilization Leader

Centene Corporation; Utah; Hybrid; USD 215.000 - 409.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Zusammenfassung

Centene Corporation seeks a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. You will provide leadership for utilization management, and participate in reviews of complex or experimental services to ensure timely decisions.

You will collaborate with clinical teams and providers, support performance improvement, and contribute to provider network development and physician education.

Qualifikationen

• 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 advantageous.
• Experience caring for a culturally diverse population preferred.

Aufgaben

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions for the business unit.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical reviews for utilization review, quality assurance, and complex or experimental services.
• Support performance improvement initiatives for capitated providers and planning of goals/policies.
• Offer medical expertise in quality improvement and utilization management programs per regulatory requirements.
• Assist in physician committee operation and membership, and conduct rounds for high‑risk patient care coordination.
• Collaborate with clinical teams, network providers, appeals team, and consultants on complex cases and medical necessity appeals.
• Participate in provider network development, market expansion, and physician education on clinical issues.

Kenntnisse

Medical leadership

Utilization management

Quality improvement

Clinical review

Regulatory knowledge

Physician collaboration

Ausbildung

MD/DO

Health admin coursework

Jobbeschreibung

Centene Corporation seeks a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement, and credentialing for the business unit. You will provide leadership for utilization management, and participate in reviews of complex or experimental services to ensure timely decisions.

You will collaborate with clinical teams and providers, support performance improvement, and contribute to provider network development and physician education.