Remote Medical Director - Quality & Utilization Leadership

Centene Corporation; 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 plus holidays

Flexible work arrangements

Job summary

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 lead utilization management, perform medical review, support performance improvement, and collaborate with clinical teams and providers to ensure high-quality, cost-effective care.

This role may require weekend/holiday coverage and offers flexible work arrangements including remote, hybrid, field, or office

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

• Assists the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions.
• Provides medical leadership of utilization management, cost containment, and medical quality improvement activities.
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex or experimental services.
• Supports performance improvement initiatives for capitated providers.
• Assists in planning and establishing goals and policies to improve quality and cost-effectiveness of care.
• Collaborates with physician committees, review teams and providers for complex cases and appeals.
• Conducts rounds to assess and coordinate care for high-risk patients with care management teams.
• Interfaces with providers to implement recommendations that improve utilization and health care quality.

Skills

Utilization management

Quality improvement

Medical leadership

Clinical collaboration

Education

MD/DO degree

Job description

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 lead utilization management, perform medical review, support performance improvement, and collaborate with clinical teams and providers to ensure high-quality, cost-effective care.

This role may require weekend/holiday coverage and offers flexible work arrangements including remote, hybrid, field, or office