Remote Medical Director - Utilization & Quality Leader

Centene Corporation; Town of Texas (WI); Hybrid; USD 237,000 - 449,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401(k) and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Corporation in Wisconsin seeks an experienced medical leader to oversee utilization management, quality improvement, and medical review for members.

You will lead clinical teams, coordinate with providers, and guide performance initiatives across capitated networks. The role requires MD/DO, board certification, and active medical practice. Expect possible weekend/holiday work as needed.

Qualifications

• Medical Doctor or Doctor of Osteopathy credentialed and licensed.
• Utilization Management experience and knowledge of accreditation standards.
• Active practice and understanding of health administration concepts.

Responsibilities

• Provide medical leadership for utilization management and quality improvement.
• Perform medical review activities ensuring timely, quality decisions.
• Support performance improvement initiatives for capitated providers.
• Assist in planning goals and policies to improve quality and cost-effectiveness.
• Collaborate with physician committees and care teams on complex cases.
• Represent the business unit on medical philosophy and policies when needed.

Skills

Utilization Management experience

Quality accreditation knowledge

Active medical practice

Health policy understanding

Education

MD/DO (Medical Doctor or Doctor of Osteopathy)

Board certification in a medical specialty

Current state MD/DO license

Job description

Centene Corporation in Wisconsin seeks an experienced medical leader to oversee utilization management, quality improvement, and medical review for members.

You will lead clinical teams, coordinate with providers, and guide performance initiatives across capitated networks. The role requires MD/DO, board certification, and active medical practice. Expect possible weekend/holiday work as needed.