Medical Director

Centene
Missouri
Workplace: RemoteFull timeUSD 225,700 - 428,900 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Skills: ["Medical leadership","Quality improvement","Clinical decision-making","Collaboration","Governance"]

Lead Centene’s medical management and health services initiatives by directing utilization management, cost containment, and medical quality improvement. Perform medical review for complex or controversial services, support performance improvement for capitated providers, and assist the Chief Medical Director with governance, physician committees, and goal-setting. Collaborate across clinical teams, network providers, and appeals to review medical necessity and claims, drive provider education, and help expand networks and markets.

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Centene
Centene
1 month ago

Medical Director

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Last checked: 27 days agoStatus: Live

Job Summary

Lead Centene’s medical management and health services initiatives by directing utilization management, cost containment, and medical quality improvement. Perform medical review for complex or controversial services, support performance improvement for capitated providers, and assist the Chief Medical Director with governance, physician committees, and goal-setting. Collaborate across clinical teams, network providers, and appeals to review medical necessity and claims, drive provider education, and help expand networks and markets.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Director level

Key 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.
  • •Conduct medical review and utilization review/quality assurance of complex, controversial, or experimental services with timely, quality decisions.
  • •Support performance improvement initiatives for capitated providers and help establish goals and policies to improve quality and cost-effectiveness.
  • •Collaborate with clinical teams, providers, appeals, and consultants to review complex cases, medical necessity appeals, and claims; participate in committees and provider network development.

Pay and Benefits

Salary: USD 225,700 - 428,900 annually
Perks:Health Insurance401kPaid LeaveEquity

Key Requirements

  • •MD or DO without restrictions.
  • •Current state medical license as an MD or DO without restrictions, limitations, or sanctions, and must be licensed in MO, IL, KS, IA, NE, MI, WI, IN, OH, or PA.
  • •Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association.
  • •Certification in Psychiatry specialty is required.
  • •Actively practice medicine; utilization management experience and knowledge of quality accreditation standards preferred.
Experience:HealthcareMedicaidMedicareUtilization management
Skills:Medical leadershipQuality improvementClinical decision-makingCollaborationGovernance
Licenses:Medical license (MO, IL, KS, IA, NE, MI, WI, IN, OH, PA)
Certifications:Board certification (American Board of Medical Specialists)Board certification (American Osteopathic Association)Psychiatry certification

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn