Remote Medical Director, Utilization & Quality Improvement

Centene; United States; Remote; USD 215,000 - 409,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K/Stock plans

Tuition reimbursement

PTO & holidays

Flexible remote/hybrid/work model

Job summary

Centene is seeking a Medical Director for remote leadership of Utilization Management and quality improvement. The role focuses on strategic planning, data analysis, and process optimization while supporting the CMO and nursing leaders.

The ideal candidate holds an MD/DO with active licensure, board-certified in Psychiatry, and extensive payer/managed care experience. Availability for weekend/holiday coverage may be required.

Qualifications

• MD/DO licensed in the United States.
• Experience in utilization management and quality accreditation standards preferred.
• Board certification in Psychiatry is required.

Responsibilities

• Direct and coordinate medical management, quality improvement and credentialing for the business unit.
• Provide medical leadership for utilization management and cost containment.
• Review medical services for medical necessity and appropriate payment.
• Support performance improvement initiatives for capitated providers.
• Develop and implement physician education on clinical issues and policies.
• Collaborate with clinical teams, network providers and appeals teams on complex cases.

Skills

Utilization Management experience

Quality improvement

Education

Medical Doctor or Doctor of Osteopathy

Board certification in Psychiatry

Current state medical license (unrestricted)

Coursework in Health Administration/Health Financing/Insurance/Personnel Management

Job description

Centene is seeking a Medical Director for remote leadership of Utilization Management and quality improvement. The role focuses on strategic planning, data analysis, and process optimization while supporting the CMO and nursing leaders.

The ideal candidate holds an MD/DO with active licensure, board-certified in Psychiatry, and extensive payer/managed care experience. Availability for weekend/holiday coverage may be required.