Join our dedicated team at Centene, a leading national organization committed to transforming healthcare for our 28 million members. As a crucial part of our Medical Management/Health Services team, you have the opportunity to make a significant impact while enjoying workplace flexibility and excellent benefits. Position Purpose: Support the Chief Medical Director in overseeing and coordinating medical management, quality improvement, and credentialing for our business unit. Provide medical leadership for utilization management, cost containment, and enhancing medical quality improvement initiatives. Conduct medical reviews related to utilization, quality assurance, and complex medical services, ensuring timely and high-quality decision-making. Assist in the effective execution of performance improvement initiatives for capitated providers. Collaborate with the Chief Medical Director to establish goals and policies aimed at improving care quality and cost-effectiveness for our members. Utilize medical expertise to manage quality improvement and utilization management programs in alignment with regulatory, state, corporate, and accreditation standards. Support the operational effectiveness of physician committees including structure, processes, and membership. Regularly round to assess and coordinate care for high-risk patients, working alongside care management teams to optimize results. Engage with clinical teams, network providers, appeals teams, and medical consultants to review complex cases and medical necessity appeals. Participate in developing provider networks and expanding into new markets as appropriate. Assist in the creation and execution of physician education related to clinical issues and policies. Identify and evaluate utilization review studies and address adverse trends in service utilization and provider patterns. Lead clinical quality improvement initiatives aimed at reducing unwarranted variations in practice, boosting care quality and cost efficiency. Foster collaborations with physicians and providers to implement recommendations that enhance utilization and healthcare quality. Review claims that involve complex or new medical services to ascertain medical necessity and appropriate payment. Build alliances with the provider community by developing and implementing effective medical management programs. Represent the business unit locally and nationally on medical philosophy and policies as needed. Participate in state committees and other ad hoc committees as required. Be available to work weekends and holidays to support business operations as necessary. Education/Experience: Medical Doctor or Doctor of Osteopathy. Preferred experience in Utilization Management and a strong knowledge of quality accreditation standards. Active practice of medicine is required. Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is beneficial. Experience managing care for culturally diverse populations is also preferred. License/Certifications: Board certification in a recognized medical specialty and a current Michigan state license as an MD or DO without restrictions. Pay Range: $221,300.00 - $420,500.00 per year Centene offers a comprehensive benefits package that includes competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible working arrangement. Your actual pay will be determined based on skills, experience, education, and other job-related factors, including full-time or part-time status. Total compensation may also include additional incentive forms. Benefits are subject to program eligibility. Centene is proud to be an equal opportunity employer committed to diversity. We value the unique perspectives that candidates from all backgrounds bring. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law. We consider qualified applicants with arrest or conviction records in accordance with local ordinances and fair chance acts.