Remote Medical Director - South Carolina

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

Job summary

A leading healthcare organization is seeking a Remote Medical Director in South Carolina to oversee medical management and quality improvement initiatives. The ideal candidate will have an MD or DO, extensive experience in utilization management, and a commitment to enhancing care quality. This role offers a competitive salary, flexible work options, and a comprehensive benefits package.

Benefits

Health insurance

401K

Stock plans

Tuition reimbursement

Paid time off

Flexible work options

Qualifications

• Active medical practice required.
• Experience with diverse populations preferred.

Responsibilities

• Assist in directing medical management and quality improvement.
• Conduct medical reviews and support performance improvement initiatives.
• Ensure compliance with regulatory and accreditation standards.

Skills

Utilization Management

Quality Improvement

Medical Leadership

Education

MD or DO

Coursework in health administration

Job description

Remote Medical Director - South Carolina

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Position Purpose: Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit.

• Provide medical leadership in utilization management, cost containment, and quality improvement activities.
• Perform medical reviews related to utilization, quality assurance, and complex or controversial services, ensuring timely decisions.
• Support performance improvement initiatives for capitated providers.
• Help establish goals and policies to improve quality and cost-effectiveness of care.
• Ensure compliance with regulatory, state, corporate, and accreditation standards in quality improvement and utilization management programs.
• Assist in physician committee operations, including structure, processes, and membership.
• Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care teams.
• Work with clinical teams, providers, and specialists on complex cases and appeals.
• Participate in provider network development and market expansion.
• Contribute to physician education on clinical issues and policies.
• Identify and evaluate utilization trends and clinical quality improvement opportunities.
• Engage with providers to implement recommendations for better utilization and quality.
• Review claims for complex or unusual services to determine medical necessity and payment accuracy.
• Build alliances with the provider community through management programs.
• Represent the business unit at public and state committees, as needed.
• May work weekends and holidays to support operations.

Education/Experience: MD or DO, with experience in Utilization Management and knowledge of accreditation standards. Active medical practice required. Additional coursework in health administration, financing, insurance, or personnel management is a plus. Experience with diverse populations preferred.

License/Certifications: Board certification in a recognized medical specialty, and a current, unrestricted South Carolina MD or DO license.

Pay Range: $221,300 - $420,500 annually. Benefits include competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work options. Compensation varies based on experience and qualifications.

Centene is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will be considered without discrimination.