Remote Medical Director: UM & Quality Strategy

Centene Corp.; Missouri; Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Health insurance

401K Plan

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Medical Director to lead Utilization Management, quality improvement, and credentialing for the business unit. This remote role supports the CMO and collaborates with nursing leaders to optimize UM processes and cost containment.

The ideal candidate holds an MD/DO with unrestricted license and is experienced in payer/managed care, clinical oversight, and regulatory accreditation standards.

Qualifications

• MD or DO with unrestricted license.
• Utilization Management (UM) experience and knowledge of accreditation standards preferred.
• Board certification in a medical specialty recognized by the ABMS or AOA required.

Responsibilities

• Provides medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Performs medical reviews related to utilization review and quality assurance.
• Supports performance improvement initiatives for capitated providers.
• Assists in planning goals and policies to improve quality and cost-effectiveness of care.
• Reviews complex or unusual services to determine medical necessity and appropriate payment.
• Coordinates care with clinical teams, providers, and appeals for complex cases.

Education

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

Job description

Centene is seeking a Medical Director to lead Utilization Management, quality improvement, and credentialing for the business unit. This remote role supports the CMO and collaborates with nursing leaders to optimize UM processes and cost containment.

The ideal candidate holds an MD/DO with unrestricted license and is experienced in payer/managed care, clinical oversight, and regulatory accreditation standards.