Join our dynamic Medical Management/Health Services team and help transform the lives of 28 million members! As a clinical professional with Centene, you will enjoy competitive benefits and a flexible work environment. Position Purpose: Assist the Chief Medical Director in leading and coordinating essential medical management, quality improvement, and credentialing functions within the business unit. Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Conduct medical reviews for utilization review, quality assurance, and complex medical services, ensuring timely and high-quality decision-making. Support the successful implementation of performance improvement initiatives for capitated providers. Assist in planning and establishing goals and policies aimed at enhancing the quality and cost-effectiveness of care and services for members. Offer medical expertise to ensure compliance with regulatory, state, corporate, and accreditation requirements in quality improvement and utilization management programs. Facilitate the functioning of physician committees, including management of committee structures, processes, and membership. Conduct rounds to assess and coordinate care for high-risk patients, working closely with care management teams to optimize health outcomes. Collaborate with clinical teams, network providers, and appeals teams to review complex cases and medical necessity appeals. Participate in provider network development and identify opportunities for market expansion. Assist in creating and implementing physician education initiatives regarding clinical issues and policies. Identify utilization review studies and evaluate trends in medical service utilization and provider practice patterns. Initiate clinical quality improvement studies to reduce unwarranted variation in clinical practices to improve overall care quality and cost. Engage with physicians to implement recommendations aimed at enhancing utilization and health care quality. Review complex or unusual claims to determine medical necessity and ensure appropriate payment. Develop strong relationships with the provider community through effective medical management programs. Represent the business unit at local and national forums on medical philosophy, policies, and related issues, as required. Attend relevant state committees and other ad hoc committees when needed. Be available to work weekends and holidays as necessary to support business operations. Education/Experience: Must possess a Medical Doctor or Doctor of Osteopathy degree. Utilization Management experience and knowledge of quality accreditation standards are preferred. Active medical practice is required. Coursework in Health Administration, Health Financing, Insurance, or Personnel Management is beneficial. Experience managing care for a culturally diverse population is a plus. License/Certifications: Must hold board certification in a recognized medical specialty and a current unrestricted South Carolina state license as an MD or DO. Compensation: Pay Range: $221,300.00 - $420,500.00 per year. Centene offers a comprehensive benefits package, including competitive salaries, health insurance, retirement plans, tuition reimbursement, paid time off, and various flexible work schedule options. Centene is proud to be an equal opportunity employer, valuing diversity and encouraging applications from all qualified candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Qualified applicants with arrest or conviction records will be evaluated per applicable laws in accordance with local ordinances.