Remote Medicare Medical Director: Quality & Utilization Leader

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

Job summary

Centene Corporation seeks a physician leader to direct medical management, quality improvement, and credentialing for the business unit. You will oversee utilization management, medical review of complex cases, and ensure adherence to regulatory standards while driving cost-effective, high-quality care for members.

Responsibilities include leading physician education, coordinating with clinical teams, and supporting provider network development and market expansion, with occasional

Qualifications

• Medical Doctor or Doctor of Osteopathy required.
• Utilization Management experience preferred.
• Active practice of medicine.
• Course work in health administration/financing is advantageous.
• Experience with diverse populations preferred.

Responsibilities

• Lead medical management, quality improvement, and credentialing for the business unit.
• Direct and coordinate utilization management, cost containment, and medical quality improvement activities.
• Review medical necessity and payment for complex or new services.
• Support performance improvement initiatives for capitated providers.
• Participate in provider network development and market expansion.
• Provide physician education on clinical issues and policies.
• Interface with providers to implement utilization and quality improvements.
• Represent the unit on state and ad hoc committees.

Skills

Utilization Management

Quality improvement

Medical leadership

Clinical collaboration

Regulatory compliance

Education

MD or DO

Health admin/financing (adv.)

Job description

Centene Corporation seeks a physician leader to direct medical management, quality improvement, and credentialing for the business unit. You will oversee utilization management, medical review of complex cases, and ensure adherence to regulatory standards while driving cost-effective, high-quality care for members.

Responsibilities include leading physician education, coordinating with clinical teams, and supporting provider network development and market expansion, with occasional