Remote Medical Director — Utilization & Quality Improvement

Centene Corporation; Missouri; Remote; USD 215,000 - 409,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Job summary

Centene Corporation seeks a Medical Director to lead utilization management, quality improvement, and credentialing initiatives remotely. The role guides data-driven decisions and strategic planning while collaborating with the Chief Medical Officer and nursing leaders.

Ideal candidates hold an MD/DO with board certification and have solid payer/managing care experience. Licensure must be active in the relevant state, with willingness to work across networks and new markets.

Qualifications

• Medical Doctor or Doctor of Osteopathy with active license.
• Utilization Management experience and knowledge of accreditation standards preferred.
• Payer/Managed Care experience strongly preferred.

Responsibilities

• Provide medical leadership for utilization management, cost containment, and quality improvement activities.
• Perform medical reviews for utilization review and quality assurance to ensure timely, high-quality decisions.
• Support performance improvement initiatives for capitated providers and coordinate with care teams.
• Plan and implement physician education on clinical issues and policies.
• Review claims for medical necessity and help optimize payment decisions.
• Engage with provider networks and committees to advance medical management goals.

Skills

Medical leadership

Utilization Management

Quality improvement

Credentialing

Strategic planning

Data analysis

Collaboration with nursing/clinical

Education

MD/DO license

Board certification (ABMS or AOA)

Job description

Centene Corporation seeks a Medical Director to lead utilization management, quality improvement, and credentialing initiatives remotely. The role guides data-driven decisions and strategic planning while collaborating with the Chief Medical Officer and nursing leaders.

Ideal candidates hold an MD/DO with board certification and have solid payer/managing care experience. Licensure must be active in the relevant state, with willingness to work across networks and new markets.