Job Description

Join our team at Centene Corporation and transform the healthcare experience for our 28 million members as a Medical Director on our Medical Management/Health Services team. At Centene, we offer a diverse working environment with competitive benefits and a strong emphasis on workplace flexibility.

We're Hiring: Remote Medical Directors

As a prominent provider of government-sponsored healthcare, Centene is dedicated to providing affordable, high-quality services to our Medicaid and Medicare members, as well as families within the Health Insurance Marketplace.

If you're looking for an incredible opportunity to make a difference beyond patient encounters and drive impactful change in the community, we want to hear from you!

Qualifications for this role include:

• MD or DO license in Indiana without restrictions
• Board certified by the American Board of Medical Specialists or the American Osteopathic Association
• Experience in Utilization Management and familiarity with quality accreditation standards
• Currently practicing medicine

Position Purpose:
Support the Chief Medical Director in guiding and coordinating medical management, quality improvement, and credentialing functions.

• Provide medical leadership for utilization management and quality improvement initiatives.
• Conduct medical review pertaining to utilization review and ensure timely, quality decision-making.
• Assist in implementing performance improvement initiatives for providers.
• Help set goals and establish policies focused on enhancing care quality and cost-effectiveness.
• Contribute medical expertise to compliance with regulatory and accreditation requirements.
• Collaborate with physician committees to optimize processes and membership.
• Conduct rounds to assess care for high-risk patients with management teams.
• Work with clinical teams and network providers on complex cases and appeals.
• Participate in provider network development and market expansion.
• Assist in physician education on clinical policies and issues.
• Identify adverse trends in service utilization and unusual practice patterns.
• Lead quality improvement efforts to reduce clinical practice variation.
• Engage with providers to enhance utilization and care quality.
• Review complex claims for medical necessity and payment appropriateness.
• Develop relationships with providers through effective medical management.
• Represent the business unit at state committees and relevant meetings.
• May require weekend and holiday work as needed.

Education/Experience:
Medical Doctor or Doctor of Osteopathy required. Utilize Management experience, quality accreditation knowledge preferred. Experience in health administration or similar fields is advantageous. Background in managing care for diverse populations is a plus.

License/Certifications:
Board certification in a recognized medical specialty and a valid Indiana MD or DO license with no restrictions or sanctions is essential.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work arrangements. Actual pay will be based on skills, experience, education, and other job-related factors permitted by law. Total compensation may also include incentives. Benefits are subject to program eligibility.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

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