Remote Medical Director — Utilization & Quality Leader

Centene Corporation; Wisconsin; 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: remote,hyb

Stock options

Job summary

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for our business unit. You will provide medical leadership for utilization management, cost containment, and medical quality improvement activities, and perform medical reviews to ensure timely, high‑quality decisions.

The role includes collaborating with care management teams, provider networks and committees, supporting performance

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

• Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions for the business unit.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
• Support performance improvement initiatives for capitated providers and coordinate with care management teams to optimize outcomes.
• Assist in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Collaborate with physician committees, provider networks, and appeals teams on complex cases and medical necessity appeals.
• Represent the business unit before state committees and other ad hoc groups as needed.
• May require weekend and holiday work in support of operations.

Skills

Utilization Management

Quality oversight

Clinical leadership

Health policy

Collaborative skills

Education

Medical Doctor (MD)

Doctor of Osteopathy (DO)

Board certification in a medical specialty

Active medical license (MD/DO)

Job description

Centene Corporation is seeking a Medical Director to assist the Chief Medical Director in directing medical management, quality improvement and credentialing for our business unit. You will provide medical leadership for utilization management, cost containment, and medical quality improvement activities, and perform medical reviews to ensure timely, high‑quality decisions.

The role includes collaborating with care management teams, provider networks and committees, supporting performance