Remote Medical Director: Utilization & Quality Leader

Centene Corporation; Minnesota; Hybrid; USD 215,000 - 409,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a medical leader to oversee utilization management, cost containment, and quality improvement activities. The role reviews complex services, supports performance initiatives for capitated providers, and assists the Chief Medical Director with goals and policies to improve care quality and cost-efficiency.

The position requires medical practice, board certification, and experience in quality accreditation.

Qualifications

• Medical Doctor or Doctor of Osteopathy.
• 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

• Provide medical leadership for utilization management, cost containment, and medical quality improvement efforts.
• Perform medical reviews for utilization review, quality assurance, and complex or novel services.
• Support performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning goals and policies to improve care quality and cost-effectiveness.
• Provide medical expertise for quality improvement and utilization management programs per regulatory standards.
• Assist in physician committee operations and membership logistics.
• Coordinate rounds to assess high-risk patients with care management teams.

Skills

Utilization management

Quality improvement

Clinical leadership

Medical review

Education

MD/DO

Practice medicine

Health admin/fin/insurance

Job description

Centene Corporation seeks a medical leader to oversee utilization management, cost containment, and quality improvement activities. The role reviews complex services, supports performance initiatives for capitated providers, and assists the Chief Medical Director with goals and policies to improve care quality and cost-efficiency.

The position requires medical practice, board certification, and experience in quality accreditation.