Medical Director

Centene Corporation

. Assist the CMO in directing and coordinating the physician component of utilization management functions for health plan business units .

Posted 10/23/2026part-timeRemote • United StatesLead💰 $103 - $196 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in utilization management and medical review, providing leadership in quality improvement initiatives while ensuring compliance with regulatory and accreditation standards. Possesses strong clinical judgment and experience in managing care for diverse populations.

Highest-signal resume keywords

Board Certified PhysicianActive Indiana MD Or DO State LicenseUtilization Management ExperienceExperience Within Managed Care OrganizationMedical Review Of Complex Services

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical ReviewUtilization ManagementQuality ImprovementClinical Quality Improvement StudiesCase ReviewsClaims ReviewEvaluation Of Utilization TrendsTransplant ReviewCulturally Diverse Population ManagementHealth Administration Coursework

Certifications & Qualifications

Board Certification Through American Board Medical SpecialtiesBoard Certification In Primary Care Specialty

Industry Keywords

Managed CareHealth Plan Business UnitsRegulatory ComplianceAccreditation RequirementsMedical Necessity DeterminationBenefit/Payment AdequacyInternal MedicineFamily PracticeEmergency MedicineMedicare Patients

About the role

Key responsibilities & impact

Assist the CMO in directing and coordinating the physician component of utilization management functions for health plan business units
Provide medical leadership for utilization management and medical review activities
Perform medical review of complex, controversial, experimental, or unusual services, including transplants, using consultants when needed
Perform case reviews and appeals for all health plans
Assist the CMO in planning goals and policies to improve quality and cost-effectiveness of care and services
Provide medical expertise for quality improvement and utilization management programs in compliance with regulatory, state, corporate, and accreditation requirements
Identify utilization review studies and evaluate adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy
Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice
Review claims involving complex, controversial, unusual, or new services to determine medical necessity and appropriate payment

Requirements

What you’ll need

Board Certified Physician
Active Indiana MD or DO state license
Current Indiana state medical license without restrictions
Board Certification through American Board Medical Specialties
Medical Doctor or Doctor of Osteopathy
Preferably board certified in a primary care specialty (Internal Medicine, Med/Peds, Family Practice, Pediatrics or Emergency Medicine) or another specialty familiar with Medicare patients
Utilization management experience is ideal
Previous experience within a managed care organization preferred
Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management preferred
Experience treating or managing care for a culturally diverse population preferred
Must be an actively practicing physician
More than one state license preferred
Approximately 20 hours per week, with Thursdays and Fridays highest priority

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Equal opportunity employer committed to diversity