Remote Medical Director: Quality & Utilization Strategy

Centene Corporation; New Mexico; 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 and holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a physician leader to direct medical management, quality improvement, and credentialing for the business unit. The role provides medical leadership for utilization management, cost containment, and quality improvement activities, and supports performance initiatives for capitated providers.

Responsibilities include planning goals, applying regulatory standards, and coordinating with physician committees to enhance care quality and manage complex cases.

Qualifications

• MD or DO with utilization management experience preferred.
• Active medical practice is required.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing functions.
• Provide medical leadership for utilization management and medical quality improvement activities.
• Perform medical reviews for utilization review and quality assurance to ensure timely decisions.
• Support performance improvement initiatives for capitated providers.
• Plan goals and policies to improve quality and cost-effectiveness of care for members.
• Provide expertise in quality improvement and utilization management programs per regulations.

Skills

Utilization Management experience

Education

Medical Doctor or Doctor of Osteopathy

Job description

Centene Corporation seeks a physician leader to direct medical management, quality improvement, and credentialing for the business unit. The role provides medical leadership for utilization management, cost containment, and quality improvement activities, and supports performance initiatives for capitated providers.

Responsibilities include planning goals, applying regulatory standards, and coordinating with physician committees to enhance care quality and manage complex cases.