Remote Medical Director, Utilization & Quality

Centene Corporation; Arizona; Hybrid; USD 236,500 - 449,300; Full time

Benefits offered by this job

Competitive pay and benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a Medical Director to lead utilization management, quality improvement, and medical review activities. You will partner with Chief Medical Director to shape goals, policies, and cost-effective care for a diverse member population.

The role requires active medical practice, board certification, and U.S. licensure, with responsibilities including review of complex cases, provider network collaboration, and participation in quality initiatives.

Qualifications

• 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

• 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, controversial, or experimental medical services.
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
• Develops alliances with the provider community through the development and implementation of the medical management programs.

Skills

Utilization Management

Quality accreditation knowledge

Medical review

Active medical practice

Health administration knowledge

Education

Medical Doctor or Doctor of Osteopathy

ABMS/AOA board certification (medical specialty)

Job description

Centene Corporation is seeking a Medical Director to lead utilization management, quality improvement, and medical review activities. You will partner with Chief Medical Director to shape goals, policies, and cost-effective care for a diverse member population.

The role requires active medical practice, board certification, and U.S. licensure, with responsibilities including review of complex cases, provider network collaboration, and participation in quality initiatives.