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.
The is a remote opportunity working in CST.
RN is highly preferred.
Position will have oversight over NICU program- experience in this area is highly preferred.
Position Purpose: Leads and directs the utilization management team to ensure the appropriate application of policy procedures and processes to help support best member outcomes. Participates in developing the utilization management strategies and objectives within utilization management to improve member care experience and the efficiencies within the department.
- Provides oversight and leadership to the development, implementation, monitoring, and ongoing improvement of the utilization management process
- Provides senior leadership team a vision and direction for the department to help achieve functional goals, and communicates goals to utilization management team
- Works with senior leadership to ensure the utilization process is integrated with other key stakeholders to manage quality and risk management issues
- Leads utilization management policies and procedures within the utilization management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
- Provides subject matter expertise to senior leadership and utilization management team on the latest utilization management policies, procedures, and standards
- Develops and implements utilization management methods, policies, and procedures to achieve cost-effective healthcare results in compliance with corporate, state and National Committee for Quality Assurance (NCQA) standards
- Reviews reports to ensure adherence to department budget and identify trends for impacting forecast
- Engages with onboarding, hiring, and training new utilization management team members to support future growth and strategy
- 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
Education/Experience:
- Requires a Bachelor's degree and 10+ years of related experience, including prior management experience.Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
- 5+ 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
