Senior Medical Director — Utilization & Quality Leader

Centene Corporation; New Hampshire (OH); Hybrid; USD 215,000 - 409,000; Full time

Job summary

Centene Corporation in New Hampshire seeks a Senior Medical Director to direct medical affairs, oversee the denials and appeals department, and lead medical leadership across utilization management, quality improvement, and provider network development.

Located in NH or willing to relocate, the successful candidate will work with NH DHHS on clinical escalations and advocacy, supervise medical directors, and ensure compliance with regulatory and accreditation standards.

Qualifications

• Medical doctor with 7+ years clinical experience.
• Managed care or ACO leadership experience preferred.
• Experience in utilization management and quality accreditation preferred.
• Active medical practice is required.
• Leadership in physician committees and medical affairs.

Responsibilities

• Lead medical affairs for the business unit and oversee denials and appeals.
• Serve as clinical executive leader with NH DHHS on escalations, hearings, and advocacy.
• Provide medical leadership for utilization management, disease management, and cost containment.
• Review complex or controversial medical services for medical necessity.
• Develop and implement physician education and quality improvement programs.
• Oversee physician advisors and medical directors.
• Interface with providers to improve utilization and care quality.
• Represent the business unit before state committees and in ad hoc groups.
• May relocate to New Hampshire.

Skills

Clinical leadership

Utilization management

Quality improvement

Provider relations

Education

MD or DO degree

Board certification (ABMS/AOA)

Job description

Centene Corporation in New Hampshire seeks a Senior Medical Director to direct medical affairs, oversee the denials and appeals department, and lead medical leadership across utilization management, quality improvement, and provider network development.

Located in NH or willing to relocate, the successful candidate will work with NH DHHS on clinical escalations and advocacy, supervise medical directors, and ensure compliance with regulatory and accreditation standards.