Remote Medical Director: Utilization & Quality

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

Benefits offered by this job

health insurance

401K and stock purchase plans

tuition reimbursement

paid time off plus holidays

Remote, hybrid, field or office work S

Job summary

Centene Corporation is seeking a clinical professional to lead Medical Management/Health Services for our 28 million members, focusing on utilization management, cost containment, and medical quality improvement. The role collaborates with physicians, care teams, and network providers to ensure timely, high-quality decisions and supports performance improvement across capitated networks.

The successful candidate will actively practice medicine, hold an MD/DO, and bring Utilization Management

Qualifications

• MD or DO medical degree.
• 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 all for 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.
• Supports effective implementation of performance improvement initiatives for capitated providers.
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
• Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.

Skills

Utilization management

Quality improvement

Clinical leadership

Education

MD/DO

Board certification

Internal or Family Medicine

Job description

Centene Corporation is seeking a clinical professional to lead Medical Management/Health Services for our 28 million members, focusing on utilization management, cost containment, and medical quality improvement. The role collaborates with physicians, care teams, and network providers to ensure timely, high-quality decisions and supports performance improvement across capitated networks.

The successful candidate will actively practice medicine, hold an MD/DO, and bring Utilization Management