Director, Utilization Management
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
This is a remote opportunity that will have UM leadership oversight for Medicare Duals Operations team.
Position Purpose: Directs the utilization management team to ensure the appropriate application of policy procedures and processes to help support best member outcomes. Oversees and manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider interactions and experience and associated regulatory and/or compliance measures
- Leads utilization management team on performance, improvement, and career growth path considerations
- Leads utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
- Reviews, analyzes, and reports on utilization trends, patterns, and impacts to deliver an effective utilization program
- Leads process improvements for the utilization management team to achieve cost-effective healthcare results and presents to senior leadership team
- Establishes policies and procedures that incorporate best practices and ensure effective utilization reviews of members
- Develops utilization management strategies and influences decisions by providing recommendations that align to organizational objectives
- Responsible for components of the department’s budget while collaborating inter-departmentally with senior leadership
- Executes the overall strategy for onboarding, hiring, and training new utilization management team members to ensure adequate training and high quality-care to improve member and provider experience and ensure compliance
- Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines
- Leads and champions change within scope of responsibility
- Performs other duties as assigned
- Complies with all policies and standards
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
4+ years management experience preferred.
Expert knowledge of industry regulations, policies, and standards preferred.
License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred
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 with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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 characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Average salary estimate
If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.
As the Director of Utilization Management at Centene, you have the exciting opportunity to transform healthcare for our 28 million members while working from the comfort of your home in Missouri! In this key role, you'll oversee the Medicare Duals Operations team, guiding them in the implementation of best practices to achieve optimal member outcomes. Your leadership will ensure that the utilization management team adheres to essential policies and procedures, promoting compliance with NCQA standards and enhancing provider interactions. You'll be responsible for analyzing utilization trends, spearheading process improvements, and collaborating closely with senior leadership to deliver strategic initiatives. By crafting effective onboarding and training programs for new team members, you’ll set the stage for high-quality care and exemplary service performance. With a focus on professional growth, you’ll lead by example and inspire your team to excel in their careers while upholding the highest standards of health management. At Centene, we pride ourselves on a culture that embraces diversity and supports flexible work arrangements, offering you competitive benefits including health insurance, retirement plans, and generous paid time off. If you’re ready to make a meaningful impact in the healthcare space while enjoying a flexible working environment, the Director of Utilization Management position at Centene could be the perfect fit for you!
Join Centene as a Customer Service Advocate II to deliver exceptional support to our members in a flexible, remote role.
Join Centene as a Care Manager to develop and facilitate care plans for members with complex mental and behavioral health needs.
Join Medtronic as a Technical Consultant to advance patient care with leading cardiac ablation technologies while working remotely across Spain.
We are seeking a highly experienced Intelligence Analysis Evaluator to enhance the evaluation processes for the Intelligence Community.
Join insightsoftware as a Professional Services Consultant, leveraging your expertise to design and implement solutions with Agility PIM.
Join Atlas Van Lines as a Logistics Intern for hands-on experience in transportation and logistics.
We are seeking an experienced Medical Science Liaison to engage with key opinion leaders in ophthalmology across Southern California on a contract basis.
Transforming the health of the community, one person at a time.
53 jobs
Subscribe to Rise newsletter
🔮
Hi, I'm Risa! Your AI Career Copilot
you, just ask me below!
Sign up for our weekly
newsletter of fresh jobs
