Senior Medical Director - Utilization & Quality

Centene Corporation; Enid (OK); 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 is seeking a medical leader to oversee utilization management, cost containment, and quality improvement activities across the network. The role requires medical oversight, clinical expertise, and active collaboration with providers and multidisciplinary teams to ensure high-quality patient care.

The position involves reviewing complex cases, supporting performance improvement initiatives, and participating in physician education and network development.

Qualifications

• 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.

Responsibilities

• Provides medical leadership of utilization management, cost containment, and medical quality improvement activities.
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
• Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Provides medical expertise in quality improvement and utilization management programs in accordance with regulatory requirements.
• Represents the business unit at state committees and other ad hoc committees.
• May be required to work weekends and holidays in support of business operations.

Skills

Utilization management

Medical leadership

Quality improvement

Physician collaboration

Regulatory compliance

Education

Medical Doctor or Doctor of Osteopathy

Board certification by the American Board of Psychiatry and Neurology

Certification in Child Psychiatry, preferred

Job description

Centene Corporation is seeking a medical leader to oversee utilization management, cost containment, and quality improvement activities across the network. The role requires medical oversight, clinical expertise, and active collaboration with providers and multidisciplinary teams to ensure high-quality patient care.

The position involves reviewing complex cases, supporting performance improvement initiatives, and participating in physician education and network development.