National Medical Director

Centene Corporation

Medical Director supporting Centene’s medical management, utilization review, and quality improvement programs. Leading complex case reviews, provider collaboration, and high-risk patient care across seven remote states.

Posted 9/10/2026full-timeRemote • Illinois, Kansas, Kentucky, Montana, New Mexico, Tennessee, Texas • 🇺🇸 United StatesLead💰 $236,500 - $449,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical management, quality improvement, and utilization management, with a focus on enhancing care quality and cost-effectiveness. Possesses strong leadership skills to collaborate with clinical teams and develop educational programs for providers.

Highest-signal resume keywords

Medical Doctor (MD) or Doctor of Osteopathy (DO)Board Certification in Medical SpecialtyUtilization Management ExperienceActive Certification in Internal or Family MedicineQuality Accreditation Standards Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical ManagementQuality ImprovementUtilization ReviewComplex Case ReviewPerformance Improvement InitiativesClinical Quality Improvement StudiesCare CoordinationProvider Network DevelopmentMedical Necessity AppealsHealthcare Quality Improvement

Soft Skills

CollaborationLeadershipCommunicationProblem-SolvingCultural Competence

Certifications & Qualifications

Board CertificationState Medical License

Industry Keywords

HealthcareQuality Accreditation StandardsCulturally Diverse PopulationHealth AdministrationHealth FinancingInsurance Management

About the role

Key responsibilities & impact

Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities
Perform medical review for utilization review, quality assurance, and complex, controversial, or experimental medical services
Support performance improvement initiatives for capitated providers
Help establish goals and policies to improve quality and cost-effectiveness of care and service
Provide medical expertise for quality improvement and utilization management programs
Assist with physician committee structure, processes, and membership
Conduct regular rounds for high-risk patients and coordinate care with care management teams
Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on complex cases and medical necessity appeals
Participate in provider network development and new market expansion
Develop and implement physician education on clinical issues and policies
Identify utilization review studies, adverse utilization trends, unusual provider practice patterns, and benefit/payment adequacy issues
Identify clinical quality improvement studies to reduce unwarranted variation in clinical practice
Interface with physicians and providers to implement recommendations improving utilization and healthcare quality
Review complex, controversial, unusual, or new-service claims for medical necessity and appropriate payment
Develop provider-community alliances through medical management programs
Represent the business unit before local and national publics, state committees, and ad hoc committees as needed

Requirements

What you’ll need

Medical Doctor or Doctor of Osteopathy
Actively practices medicine
Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services
Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs
Utilization Management experience and knowledge of quality accreditation standards preferred
Active Certification in Internal or Family Medicine preferred
Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous
Experience treating or managing care for a culturally diverse population preferred
May be required to work weekends and holidays in support of business operations, as needed

Benefits

Comp & perks

Competitive pay
Health insurance
401K
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 employment
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act