Remote Medical Director - South Carolina

RemoteWorker US; Central (SC); Remote; USD 221,000 - 421,000; Full time

Job summary

A leading healthcare organization is seeking a Remote Medical Director to lead their Medical Management team. This role offers the chance to impact healthcare for millions, with responsibilities including medical leadership, quality improvement initiatives, and regulatory compliance. The position allows for flexible remote work and comes with a competitive salary and benefits package.

Benefits

Health insurance

401K

Stock plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Qualifications

• MD or DO with board certification required.
• Active medical license in South Carolina.
• Experience in utilization management preferred.

Responsibilities

• Provide medical leadership in utilization management and quality improvement.
• Conduct medical reviews and ensure compliance with standards.
• Collaborate with clinical teams on complex cases.

Skills

Utilization management

Quality improvement

Credentialing

Healthcare policy

Education

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

Board certification in a recognized medical specialty

Active South Carolina medical license

Coursework in health administration

Job description

Remote Medical Director - South Carolina

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Position Overview

We are seeking a qualified Medical Director to lead our Medical Management/Health Services team. This role offers a flexible, remote working environment and the opportunity to impact healthcare for 28 million members.

Responsibilities

1. Provide medical leadership in utilization management, quality improvement, and credentialing.
2. Perform medical reviews for utilization, quality assurance, and complex medical services.
3. Support performance improvement initiatives for capitated providers.
4. Assist in planning and establishing policies to improve care quality and cost-effectiveness.
5. Ensure compliance with regulatory and accreditation standards in quality and utilization management programs.
6. Participate in physician committee functions and provider network development.
7. Conduct rounds for high-risk patient care coordination.
8. Collaborate with clinical teams and providers on complex cases and appeals.
9. Develop physician education programs and identify clinical quality improvement opportunities.
10. Review claims for complex or unusual services to determine medical necessity.
11. Build alliances with the provider community and represent the organization at public forums.

Qualifications

• Medical Doctor (MD) or Doctor of Osteopathy (DO).
• Board certification in a recognized medical specialty.
• Active South Carolina medical license.
• Experience in utilization management and quality standards preferred.
• Additional coursework in health administration or related fields is advantageous.

Compensation & Benefits

Salary range: $221,300 - $420,500 annually. Benefits include health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work arrangements.

Additional Information

Centene is an equal opportunity employer committed to diversity. We consider qualified applicants regardless of background, including those with criminal records, in accordance with applicable laws.